Patient Hospital Experience

This section discusses how the evaluation process works and 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 Utah Artificial Heart Program (UAHP) at LDS Hospital by a
  • Cardiologist
  • Family practice clinician
  • Internal medicine clinician
• Patient is a self-referral
  • Patient/family member contacts UAHP 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.

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 are given to and discussed with the patient and caregiver(s) prior to a final decision being made by the patient.

Surgery

Prior to surgery, consideration is taken to ensure that the patient is in optimal physical condition to undergo surgery.

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 1½ 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 tolerable 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.

Post operative-Acute Coronary Care Unit (ACCU)

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 telemetry and are cared for by a certified mechanical circulatory support nurse. Management of the patient's medical needs is transferred from the critical care team to the Heart Failure Prevention and Treatment Program team.

Patients usually spend about 1½ to 2 weeks in the Intermediate Care Unit.

Discharge

The discharge process begins once the patient and caregiver makes the decision to have the LVAD implanted. Verbal, written and visual educational materials are provided throughout this process and are available to anyone involved in the patient's care at home (clinicians and non-clinicians).

When the patient is ready for home discharge, the patient and their 24-hour caregiver will move from the hospital to their home (if location permits) or to the LVAD House (See Patient and Family section for additional information regarding the LVAD House).

At the time of discharge to home, the Utah Artificial Heart Program 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.