Heart failure treatment - Devices and surgery

- So let's say a patient's Heart Failure gets to this point where medications and lifestyle changes help but really, they just aren't enough. And the patient's symptomatic almost all the time. Well, that's when we start to think about medical device implants or surgery. So there are actually a few types of medical devices that can be used. And the first one we call the ventricular assist device or sometimes just the VAD, V-A-D. This device assists or it helps the patient's ventricle or ventricles. Since with Heart Failure one or both ventricles aren't pumping very well, these devices actually help out with that and essentially take over the pumping for the ventricle. And so how they typically work is that there's this small tube that attaches to the ventricle that needs help. And we'll say that in this case the left ventricle needs help. And so it's coming from the bottom of the ventricle, here. So at this point the blood, instead of exiting out the artery as you'd normally expect it to, it sort of rerouted, here. And so it goes through this tube to this separate pump. The VAD then pumps it out through this next tube which connects up with the artery and then leaves the heart. So we're sort of bypassing this whole area and letting the VAD shoulder all the pumping work. These VADs are usually connected to a small control unit that's actually outside the body. So a cable goes from the inside, connected to the VAD, through a small hole in the abdomen, to a control unit that's outside, and it's also connected to some batteries. Both of which are usually kind of worn with straps over the body. So I drew it for the left ventricle and so usually we call that a left VAD or an LVAD. But you can certainly have one for the right ventricle too. And we call that an RVAD or a right VAD. Those usually connect up to the right atrium, take blood to the pump, and then give it back to the artery on the right side, which heads off to the lungs. You can even have a BiVAD, meaning that there's a pump for each ventricle. And depending on the VAD it may pump blood just like your heart does, kind of rhythmically. But it could also be a continuous flow of blood. So in that case, there's no pumping. And you might not have a normal pulse but your body's still getting the blood that it needs. Implantable VADs are usually reserved for people who are either waiting for a heart transplant or as a long term solution for those that actually can't have heart transplants. So the other type of medical device implant is something called Cardiac Resynchronization therapy. This could be a pacemaker only or it could be a special dual pacemaker and defibrillator. For the pacemaker you have this small device that's implanted in the chest. And then these electrical wires are, sometimes we call them leads, that go from the device to both the left and the right ventricles. One thing to notice though, is that to actually get to the left ventricle they have to go in through your coronary veins and then kind of go around the heart to the outside of the left ventricle. And that's why I kind of drew it dotted as it, as soon as it's going, sort of around the backside. With Heart Failure we know that both the right and the left ventricles can be affected differently, right? And so what can happen is that they beat at different times. And this makes the heart a way less efficient pump. The pacemaker sends signals down these wires or these leads at the same time to tell both ventricles to pump at the same time, leading to a much more normal and efficient pumping action. Now this device might also come with what's called a defibrillator. If the patient's Heart Failure leads to life threatening rapid heart rates, and then it's going sort of uncontrollably fast, the device can deliver a shock that sort of resets the heart to a normal rhythm. But besides medical device implants a patient can also have a surgical intervention. And so they might be given stents to help with blood flow for coronary artery disease. These are placed over areas in the arteries that have plaque buildup which help to widen the arteries and make it easier for blood to flow through them. And so then it's easier for the heart to pump through them. Another surgery is called a coronary artery bypass. This surgical technique bypasses or sort of reroutes the blood supply around a blocked artery instead. Again, just like a stent it makes it a lot easier to pump through this artery that's not blocked anymore, right? Usually the doctor connects or sometimes we say grafts a healthy artery from somewhere else in the body where its absence isn't as much of a big deal. Finally, what's considered the ultimate surgical intervention is a complete heart transplantation. This is where the patient's entire heart is removed and replaced with a healthy donor heart. And this procedure is really limited to patients that are considered at end stage Heart Failure or where other medical treatments in surgery have failed.