Specialist treatment for advanced heart failure

Heart failure is a complex condition and often requires a combination of treatments. At Harefield Hospital, patients with advanced heart failure are treated with ventricular assist device (VAD) surgery using a minimally invasive approach, or heart transplantation may also be offered as a last resort. 

It is estimated that nearly a million people in the UK are living with heart failure. This is a long-term condition and occurs when the heart doesn’t pump blood as efficiently and effectively as it should. Up to 15% of patients with heart failure may also have advanced heart failure.  

Typical symptoms of heart failure can include fluid build-up, excessive tiredness and shortness of breath, particularly when exercising or lying down. Heart failure can develop suddenly or more gradually over a period of time. Common causes of heart failure include heart attack, high blood pressure, and cardiomyopathy. 

For many people, heart failure requires life-long treatment with specialist medications, but when there is a specific cause of heart failure – such as clogged arteries, damaged valves or heart rhythm abnormalities – interventional procedures or surgery may also be recommended. 

Treatment include the implantation of a defibrillator,to give small electrical shocks to help control arrhythmias, or a resynchronization therapy pacemakerto keep the heartbeat regular, or both options.This can be done under local anaesthesia as a day case procedure, this can help save lives and improve quality of life. 

Advanced heart failure requires even more intensive treatment; options include heart transplantation and ventricular assist devices.  

Harefield Hospital is one of the leaders in heart transplantation as well as ventricular assist device (VAD) technology and implantation. The implantable device acts as an artificial heart pump and is used to treat people with severe heart failure. It helps the failing heart and aims to restore normal blood supply to the other organs in the body. 

The implanted device acts as a pump to circulate blood from the main chamber of the heart around the body. VADs are designed to assist either the right ventricle (RVAD) or the left ventricle (LVAD), and in some instances to assist both ventricles (BiVAD). LVAD is the most commonly performed surgery with patients going on to lead a relatively normal lifestyle.  

Minimally invasive device implantation

Surgical intervention can save a patient’s life by allowing the heart to function correctly.  

The VAD programme at Harefield Hospital is one of the world’s most established. The experts at Harefield Hospital have been performing the procedure for over 20 years, and it has one of the highest success rates in the UK. The expert team implant the largest number of devices in the UK and many overseas teams visit the hospital for training. 

Harefield Hospital is the only centre in the UK to implant the VAD using minimally invasive surgery. This approach uses two small incisions (sternum-sparing), rather than a traditional  full sternotomy method, which allows for lower rates of infection and faster recovery times. Additionally, this approach also has enormous benefits for any additional surgeries. 

In the last decade, a significant number of people have received this device instead of a heart transplant. This works well for patients unsuitable for heart transplants, especially if they have underlying health problems or weight issues. The development of VADs have allowed permanent implantation and can significantly increase the patient’s quality and length of life. 

Testing, diagnostics and aftercare

Assessment for a ventricular assist device (VAD) is done by a multi-disciplinary team and involves an extensive pre-screening and is performed before the VAD implantation is recommended. This includes blood tests, echocardiogram, CT scans, angiogram (cardiac catheterisation), ECG, renal function, lung function as well as psychological testing. This process identifies if the patient is suitable for the device and will benefit from implantation of the device. 

Once the VAD is implanted, patient aftercare is paramount for long-term results. This includes follow-ups with trained nursing staff, cardiac rehabilitation, and a 24-hour on-call service. 

Harefield Hospital is a specialist cardiothoracic centre with experience of treating extremely complex cases of heart failure and advanced heart failure. The hospital’s specialist teams have an enormous amount of experience and expertise in ventricular assist device (VAD) implantation and aftercare compared to other hospitals.