Ventricular assist devices (VADs) are mechanical pumps that support heart function for those with weakened hearts. There are three main types - right VAD, left VAD (LVAD), and bi-VAD. LVADs are the most common and have three parts: an inflow cannula, pump, and outflow cannula. There are two methods of blood circulation for LVADs - continuous flow and pulsatile flow. Occupational therapy can help restore function for those with VADs through increasing activity tolerance, caregiver education, and addressing psychosocial issues from the major life change.

1. Ventricular Assist Devices
Anya Chappell, MSOT

2. Definition: a mechanical pump used to to support
heart function and blood flow in people who have
weakened hearts.
People may require a VAD when the heart is unable to
pump blood at a sufficient rate to meet the demands
of the body
Treatment Approaches
 Bridge-to-transplant
 Destination Therapy
 Bridge-to-recovery
Ventricular Assist Device (VAD)
(Gill Heart Institute , 2014)

3. Three types of VADs:
1. Right Ventricular Assist Device (VAD)- Pumps
blood from right ventricle through pulmonary
artery to lungs
2. Left Ventricular Assist Device (LVAD)- Pumps
blood from left ventricle through aorta to body-
Most common.
3. BiVADs- used when both ventricles do not
function properly. Many people also use a Total
Artificial Heart (TAH) in these cases.
Ventricular Assist Device (VAD)

4. 2 methods for blood circulation
1. Continuous Flow- circulates blood continuously using an
internal rotor. Patient does not have pulse.
2. Pulsatile pumps- mimics the natural pulsing action of the
heart. The blood volume of the heart varies during a cycle.
All LVADs have 3 standard components
1. Inflow Cannula- drains blood from the heart into the pump
from left ventricle
2. Pump- moves blood from one tube to another
3. Outflow Cannula- returns blood to the aorta from the pump
to circulate in body
Left Ventricular Assist Device (LVAD)
(Cheng, Williamitis, & Slaughter, 2014)

5. HeartWare
Common Devices Used at Mayo

6. HeartMate II

7. HeartAssist 5

8. https://www.youtube.com/watch?v=mOZIYoq32SQ
1:13sec
LVAD Video

9. There are several external parts that are important
to consider during therapy:
Drive line exit site- connects internal pump to
external controller. Exits from skin on abdomen.
Controller- operates pump to keep heart working,
if anything goes wrong, alarms will sound. Must be
hooked to a power source at all times.
Battery pack/power source- LVAD will NOT operate
without this. Must be worn close to body at ALL
times with shoulder harness or side bag.
External Parts

10. External Parts

11. Percutaneous Ventricular Assist
Device (pVAD)

12. A continuous-flow heart assist device that is located
outside the body.
Primarily used for patients with Cardiogenic Shock-
Heart is not able to pump enough blood to meet the
body’s needs (Thomas et al. 2010).
• Provides hemodynamic support during or before
high-risk cardiac interventions
• Patient is stabilized using pVAD and
surgery/procedure is performed when patient is
able to tolerate it.
Used only as a short term solution for a maximum of
two weeks as a bridge to definitive therapy.
Percutaneous Ventricular Assist
Device (pVAD)

13. Participants:
 N = 54 patients preparing for major coronary intervention
 Comorbidities = PAD, diabetes, LVEF <20%, hypertension, previous
CABG, recent MI.
• Made all participants poor candidates for open heart
surgery
 All All received TandemHeart devices to stabilize condition prior to
procedure.
Results:
 Procedural success = 97%
 Survival rate at 30 days = 90% as compared to a predicted 67%
 Survival rate at 6 months = 87%
 Mean pVAD support time was 2hr and 3 minutes with a range of 30
min to 22 hrs.
Statistics of pVAD at Mayo Clinic
(Alli, Singh, Holmes, Pulido, Park, & Rihal, 2012)

14. Procedure:
Can be inserted in the cardiac catheterization lab
rather than requiring open heart surgery.
An atrial cannula is placed using a catheter in femoral
vein.
Cannula is inserted into right atrium, through
septum, into left atrium
Oxygenated blood is drawn out through femoral
vein, through pump, and re-inserted into body
through femoral artery to perfuse body tissues.
https://www.youtube.com/watch?v=alTp5_p-dmA
Percutaneous Ventricular Assist
Device (pVAD)

15. Sternal precautions (LVADs)
Avoid activities that may cause VAD lines to kink, pull or
twist. Keep VAD lines in sight during all movements to avoid
any interference of blood flow
Do not soak in water (bath, swimming, or sauna)
LVAD patient’s should be mobilized similar to any other ICU
patient
**Patients who engage in early mobilization after LVAD
surgery have better outcomes and increased functional
capacity
For pVADs:
Avoid valsalva
Bedrest with passive ROM and bed positioning IF service
orders
Therapy Precautions (Freeman & Maley, 2013)

16. Increase activity tolerance and reduce generalized
weakness
• Teach to manage activity level independently
• Practice daily activities to increase endurance
Practice body positioning/awareness that will protect
lines
Cognitive retraining (Petrucci et al., 2006)
Remediation of hand weakness and discoordination
Caregiver/family education
How OT can restore function

17. Patient education
 Site/wound care
 Bathing/Shower routine (~20 min)
 Dressing with lines
 Changing batteries/device management
 Intimacy with new device
Psychosocial issues may be present due to major life
change
 Anxiety/depression
 Decreased self-esteem/body image
 Decreased independence
How OT can restore function

18. Questions???

19. Lawton IADL Assessment

20. Purpose:
 The Lawton is used as a quick screening tool to measure independent
living skills and assess whether a patient is safe to return home. This
tool can be used by itself or to determine if the patient would benefit
from further, more substantial, IADL assessment (i.e. Texas Functional)
 can be used as a one time measure or to assess baseline with periodic
assessments.
Target Population:
 primarily used with older adults in hospitals, clinics, or community
health agencies. Often used with people who score poorly on cognitive
screens.
Administration Time: 10-15 minutes
Cost: FREE!!
Areas Assessed:
 telephone use, laundry, shopping, meal preparation, community
mobility, medication management, finances, and housekeeping.
Lawton IADL Assessment

21. Administration:
Questionnaire contains 8 categories to be discussed with
either patient or family member, or through a written
questionnaire.
Items do NOT need to be covered in order
Ask the patient to describe functioning in each category,
then ask patient specific questions to further clarify
description.
Example:
“Do you own a telephone?”
“What do you do if you need to call someone?”
“How do you find a number?”
Lawton IADL Assessment

22. Scoring:
Each category is given a score of either 0 or 1
depending on the patient’s response
Scores are added to form a summary score between 0
(low functioning/dependent) and 8 (high
functioning/independent)
Therapists can also look at individual scores to identify
specific problem areas to address in therapy
There are no specific guidelines on how to interpret
results  Safety of patient to return home is left up to
therapist’s interpretation.
Lawton IADL Assessment

23. Strengths:
 Short administration time, useful during initial evaluation when
time is limited
Can be done using a casual conversation style
Can identify specific problem areas to be assessed further
Weaknesses:
Developed in 1969, so somewhat outdated
Relies on self report not objective measure
Scoring is very vague and open to personal interpretation
Limited data on reliability and validity
 Reliability = .85 (Graf, 2006) – both reliability and validity need to be
further tested.
Lawton IADL Assessment

24. Lets all PRACTICE!!
Lawton IADL Assessment

25.  Alli, O. O., Singh, I. M., Holmes, D. R., Pulido, J. N., Park, S. J., & Rihal, C. S.
(2012). Percutaneous left ventricular assist device with TandemHeart
for high‐risk percutaneous coronary intervention: The Mayo Clinic
experience. Catheterization and Cardiovascular Interventions, 80(5),
728-734.
 Cheng, A., Williamitis, C. A., & Slaughter, M. S. (2014). Comparison of
continuous-flow and pulsatile-flow left ventricular assist devices: is
there an advantage to pulsatility? Annals of cardiothoracic surgery,
3(6), 573.
 Freeman, R., & Maley, K. (2013). Mobilization of intensive care cardiac
surgery patients on mechanical circulatory support. Critical care
nursing quarterly, 36(1), 73-88.
 Gill Heart Institute (2014). VAD parts and Surgery. University of Kentucky.
Retrieved from http://ukhealthcare.uky.edu/gill/vad-parts/
 Gilotra, N. A., & Stevens, G. R. (2014). Temporary Mechanical Circulatory
Support: A Review of the Options, Indications, and Outcomes.
Clinical Medicine Insights. Cardiology, 8(Suppl 1), 75.
References

26.  Graf, C. (2006). Functional decline in hospitalized older adults.
American Journal of Nursing, 106(1), 58-67.
 Loewenstein, D. A., & Mogosky, B. J. (1999). The functional
assessment of the older adult patient. In P. Lichtenberg (Ed.),
Handbook of assessment in clinical gerontology (pp. 529-554).
New York: John Wiley & Sons.
 Petrucci RJ, Truesdell KC, Carter A, et al. (2006). Cognitive Dysfunction
in Advanced Heart Failure and Prospective Cardiac Assist Device
Patients. Ann Thorac Surg;81(5):1738-1744.
 Shepherd, J., & Wilding, C. (2006). In practice. Occupational therapy
for people with ventricular assist devices. Australian
Occupational Therapy Journal, 53(1), 47-49.
 Thomas JL, Al-Ameri H, Economides C, et al. (2010). Use of a
percutaneous left ventricular assist device for high-risk cardiac
interventions and cardiogenic shock. Journal of Invasive
Cardiology. 22(8) 360-364.
References