This section discusses what the patient experiences (related to device implantation) during the LVAD work-up, hospitalization, and discharge processes.
Evaluation Work-up Process/Pre-op
A detailed work-up process for those suffering with advanced heart failure (NYHA Class IIIB/IV) begins in one of two ways:
- Patient is referred to the Artificial Heart Program by a:
- Family practice clinician
- Internal medicine clinician
- Patient is a self-referral
- Patient/family member contacts our program for assistance
During the work-up process, the patient will undergo a variety of tests and consultations. It is not uncommon for the patient to be admitted to the hospital for a few days for further evaluation. The patient will also be able to meet with a current LVAD patient to discuss that patient's experiences and lifestyle changes.
Once all the data is collected, the UAHP and the multi-disciplinary team (critical care physicians and nurses, heart failure and transplant nurses, social workers, and speech, occupational, and physical therapists) convenes to discuss patient candidacy. Once LVAD candidacy is established, additional educational information about the LVAD experience is given to and discussed with the patient and caregiver(s) prior to a final decision being made by the patient.
Prior to surgery, consideration is taken to ensure that the patient is in optimal physical condition.
Implantation of the LVAD involves open-heart surgery, and consequently requires the use of cardiopulmonary bypass. Length of surgery can vary from about six to twelve hours, depending on whether the patient requires other cardiac surgical procedures.
Post-operative-Thoracic Intensive Care Unit (TICU)
After surgery, the patient will be taken to the TICU. The patient's medical needs will be managed by the critical care physician. Length of stay in the TICU is dependent upon the patient's own recovery time, which may be shorter or longer then the average length of TICU stay. On average, most patients are in the TICU for 1 to 2 weeks.
Upon arrival in the TICU, the patient will most likely have the following:
- Heart monitor (telemetry) - to monitor heart rate and rhythm
- Breathing tube (endotracheal tube) - to assist with breathing and maintain and open airway
- Naso-gastric (NG) tube - to keep the stomach empty when connected to suction; to have the capability of administering oral medications directly into the stomach
- Foley catheter - to measure urinary output
- Swan-Ganz - to measure pressures within the heart
- Arterial line catheter - to measure arterial blood pressure
- Chest tubes - to collect and measure drainage from surgery
- LVAD driveline - exits the skin in the abdominal area and is connected to the LVAD power source
- Temporary pacemaker wires - used in the event of an arrhythmia associated with heart surgery
- In regard to medications, the patient will be sedated and pain medications will be managed by the critical care physician and the patient's nurse in order to achieve a level of comfort.
- Patients will also be on inotropic IV medications until the patient is hemodynamically stable and these medications can be weaned to off.
Cardiovascular or "Step Down" Unit
Once the patient is hemodynamically stable, extubated, and de-lined, the patient will be transferred to the intermediate care unit. The patient will remain on a heart monitor and cared for by a VAD coordinator. Management of the patient's medical needs is transferred from the critical care team to the heart failure team.
Patients usually spend about 1 to 2 weeks in the Intermediate Care Unit.
Throughout the patient's stay in the hospital, the team is preparing him/her and their caregiver for discharge. Verbal, written and visual educational materials are provided along with frequent hands on training.
When the patient is ready for home discharge, the patient and their 24-hour caregiver will move from the hospital to their home. Some patients who live out of state may temporarily stay at the hospital's nearby "LVAD apartments" until they feel ready to travel home.
At the time of discharge, our team will arrange home equipment and training with the patient's clinician as well as the local fire department, emergency personnel, and any other community members who wish to be trained. Also, the patient's home environment will be inspected for safety.
After the patient is discharged home, he or she will return to our clinic at Intermountain Medical Center for regular follow-up appointments. These appointments will occur two to three times a week initially, and over time will decrease to once a week, every two weeks, and every three months. At clinic appointments, the patient will meet with a heart failure doctor, nurse, pharmacist, and VAD coordinator.