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Ventricular assist device
A ventricular assist device (VAD) is an electromechanical device that provides support for cardiac pump function, which is used either to partially or to completely replace the function of a failing heart. VADs can be used in patients with acute (sudden onset) or chronic (long standing) heart failure, which can occur due to coronary artery disease, atrial fibrillation, valvular disease, and other conditions.
VADs may be used to manage a variety of cardiac diseases and can be categorized based on which ventricle the device is assisting, and whether the VAD will be temporary or permanent.
Ventricular Assistance
First, VADs can be categorized based on whether they are designed to assist the right ventricle (RVAD) or the left ventricle (LVAD) or to both ventricles (BiVAD). The type of VAD implanted depends on the type of underlying heart disease (e.g. patients with right ventricular failure from pulmonary arterial hypertension may require an RVAD, versus those with left ventricular failure from a myocardial infarction may require an LVAD). The LVAD is the most common device applied to a defective heart (it is sufficient in most cases; the right side of the heart is then often able to make use of the heavily increased blood flow), but when the pulmonary arterial resistance is high, then an (additional) right ventricular assist device (RVAD) might be necessary to resolve the problem of cardiac circulation. If both an LVAD and an RVAD are needed a BiVAD is normally used, rather than a separate LVAD and RVAD.[citation needed]
Duration
VADs can further be divided by the duration of their use (i.e. temporary versus permanent). Some VADs are for short-term use, typically for patients recovering from myocardial infarction (heart attack) and for patients recovering from cardiac surgery; some are for long-term use (months to years to perpetuity), typically for patients with advanced heart failure[citation needed]
Temporary use of VADs may vary in scale (e.g. days to months) depending on a patient's condition. Certain types of VADS may be used in patients with signs of acute (sudden onset) heart failure or cardiogenic shock as a result of an infarction, valvular disease, among other causes. In patients with acute signs of heart failure, small percutaneous (introduced to the heart through the skin into a blood vessel rather than through an incision) VADs such as the Impella 5.5, Impella RP, and others can be introduced to either the left or right ventricle (depending on the patient-specific needs) using a wire and that is introduced through the arteries or veins of the neck, axilla, or groin.
Long-term use of VADs may also vary in its scale (i.e. months to permanently). VADs that are intended for long term use are also termed "durable" VADS, due to their design to function for longer periods of time compared to short term VADs (e.g. Impella, etc.). The long-term VADs can be used in a variety of scenarios. First, VADs may be used as bridge to transplantation (BTT) – keeping the patient alive, and in reasonably good condition, and able to await heart transplant outside of the hospital. Other "bridges" include bridge to candidacy (used when a patient has a contraindication to heart transplantation but is expected to improve with the VADs support) , bridge to decision (used to support a patient while their candidacy status is decided), and bridge to recovery (used until a patient’s native heart function improves after which the device would be removed). In some instances, VADs are also used as destination therapy (DT) which indicates that the VAD will remain implanted indefinitely. VADs as destination therapy are used in circumstances where patients are not candidates for transplantation and will thus rely on the VAD for the remainder of their life.
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Ventricular assist device
A ventricular assist device (VAD) is an electromechanical device that provides support for cardiac pump function, which is used either to partially or to completely replace the function of a failing heart. VADs can be used in patients with acute (sudden onset) or chronic (long standing) heart failure, which can occur due to coronary artery disease, atrial fibrillation, valvular disease, and other conditions.
VADs may be used to manage a variety of cardiac diseases and can be categorized based on which ventricle the device is assisting, and whether the VAD will be temporary or permanent.
Ventricular Assistance
First, VADs can be categorized based on whether they are designed to assist the right ventricle (RVAD) or the left ventricle (LVAD) or to both ventricles (BiVAD). The type of VAD implanted depends on the type of underlying heart disease (e.g. patients with right ventricular failure from pulmonary arterial hypertension may require an RVAD, versus those with left ventricular failure from a myocardial infarction may require an LVAD). The LVAD is the most common device applied to a defective heart (it is sufficient in most cases; the right side of the heart is then often able to make use of the heavily increased blood flow), but when the pulmonary arterial resistance is high, then an (additional) right ventricular assist device (RVAD) might be necessary to resolve the problem of cardiac circulation. If both an LVAD and an RVAD are needed a BiVAD is normally used, rather than a separate LVAD and RVAD.[citation needed]
Duration
VADs can further be divided by the duration of their use (i.e. temporary versus permanent). Some VADs are for short-term use, typically for patients recovering from myocardial infarction (heart attack) and for patients recovering from cardiac surgery; some are for long-term use (months to years to perpetuity), typically for patients with advanced heart failure[citation needed]
Temporary use of VADs may vary in scale (e.g. days to months) depending on a patient's condition. Certain types of VADS may be used in patients with signs of acute (sudden onset) heart failure or cardiogenic shock as a result of an infarction, valvular disease, among other causes. In patients with acute signs of heart failure, small percutaneous (introduced to the heart through the skin into a blood vessel rather than through an incision) VADs such as the Impella 5.5, Impella RP, and others can be introduced to either the left or right ventricle (depending on the patient-specific needs) using a wire and that is introduced through the arteries or veins of the neck, axilla, or groin.
Long-term use of VADs may also vary in its scale (i.e. months to permanently). VADs that are intended for long term use are also termed "durable" VADS, due to their design to function for longer periods of time compared to short term VADs (e.g. Impella, etc.). The long-term VADs can be used in a variety of scenarios. First, VADs may be used as bridge to transplantation (BTT) – keeping the patient alive, and in reasonably good condition, and able to await heart transplant outside of the hospital. Other "bridges" include bridge to candidacy (used when a patient has a contraindication to heart transplantation but is expected to improve with the VADs support) , bridge to decision (used to support a patient while their candidacy status is decided), and bridge to recovery (used until a patient’s native heart function improves after which the device would be removed). In some instances, VADs are also used as destination therapy (DT) which indicates that the VAD will remain implanted indefinitely. VADs as destination therapy are used in circumstances where patients are not candidates for transplantation and will thus rely on the VAD for the remainder of their life.