The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on short-term circulatory support with left ventricular assist devices as a bridge to cardiac transplantation or recovery.
Heart failure may be managed by a combination of medical therapy, intra-aortic balloon pumping and heart transplantation.
A temporary solution for patients who are waiting for a heart transplant is to insert an LVAD into the chest near the heart. The LVAD is a mechanical device that helps the heart to pump blood around the body. LVADs can be used to support the heart while it is recovering from a severe short-term heart failure syndrome (such as myocarditis). LVADs are sometimes also used while waiting for the heart to recover after cardiac surgery. This short-term mechanical support is sometimes described as bridging.
Several different LVADS are available and your surgeon will choose the one that is most suitable for you. The surgery to implant the device into the heart takes several hours and is done under general anaesthetic. The surgeon will cut through the chest wall. The LVAD has two pipes. One (the inflow) is inserted into the left side of the heart and the other (the outflow) is inserted into an artery, usually the aorta (the main artery from the heart to the body). The LVAD pumps oxygenated blood from the heart into the arteries.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.