Mechanical Circulatory Support Patient Guide
The program's team consists of cardiologists, cardiovascular and transplant surgeons, and specially trained nurses. It also includes four coordinators who are available 24/7, dedicated dietitians, social workers, psychiatrists, financial coordinators, physical and occupational therapists, and pharmacists.
Mechanical circulatory support (MCS) is a way of improving blood flow using an implanted, electronically powered heart pump. The pump works in coordination with the heart to improve blood flow.
Your initial visit will include an evaluation of your medical history and discussions about the causes of heart failure and your treatment options. You will undergo a variety of tests during your evaluation. Based on the results of these tests and your individual case, additional tests may be needed. Testing includes:
- Blood tests to help us find out how much heart disease you have and how well other organs are functioning
- Urine tests to look for diseases, drugs or alcohol in your body
- An electrocardiogram, echocardiogram, cardiac catheterization and/or stress test to show overall heart function and strength
- Lung tests, pulmonary function and cardiopulmonary exercise tests, chest X-rays, chest CT scans and other imaging tests to look at overall health of your lungs
- A colonoscopy
We also ask our patients to complete a quality of life assessment before and after surgery. This information will help us improve our program and other MCS programs across the country.
Upon completion of all required tests, our MCS team reviews your case during a patient selection meeting. The entire team decides if you are a good candidate for an MCS device — no one person makes the decision. The team considers all information and uses a number of criteria to determine candidacy.
You might be approved for an MCS device if you have:
- Severe heart disease and a device is the best treatment available for your condition
- No problems besides your heart issue that would shorten your life or increase the risk of bleeding, clotting or infection
You would not qualify for an MCS device if you have:
- An active infection
- An active ulcer disease or bleeding
- Severe diabetes that has affected your other organs, preventing you from healing
- A high risk of not staying with the strict routine of medications or follow-up visits and examinations
You also might not be a good candidate for an MCS device if you:
- Are older than 80
- Have kidney, lung, liver or blood-circulation problems
- Cannot be reliable, cannot show that you have people to support you, or do not have a permanent place to live
- Have mental or memory problems that would limit your understanding of the required medical regimen
- Are actively consuming large amounts of alcohol or taking recreational drugs
- Cannot pay for medications, MCS supplies and equipment
During surgery you will be given general anesthesia or medication that will put you to sleep, block pain and keep your body still so that the surgeons can operate safely. An anesthesiologist will explain the anesthesia process before the surgery.
Once you are asleep, a tube will be placed down your throat and into your lungs that is connected to a machine that helps you breathe during surgery and, if necessary, after surgery. You will have a tube in your forearm that measures your blood pressure, and another tube in your bladder to drain your urine. You also may have a tube threaded through your nose and into your stomach to drain the contents of your stomach and prevent vomiting.
Once those tubes are in place, the surgeon will make an incision down the front of your chest. The ribs will be opened to expose your heart. Tubes will then be connected from your heart to a heart-lung machine, which provides oxygen to your blood and allows the surgeon to work on your heart more safely.
The surgeon will then sew in tubes that connect to the device's pump or pumps. Depending on the type of device being implanted, the pump may be on the inside or outside of your body. If inside, the surgeon will make a for the pump in the upper stomach area. If outside, the surgeon will take the tubes attached to the heart and tunnel them out of the body through incisions in the skin.
If you are getting a Total Artificial Heart, the surgeon will remove most of your heart and replace it with the heart pump. The tubes will be connected from the artificial heart to an external pneumatic driver.
At the end of the surgery, tubes will be placed on both sides of your chest to let fluid and blood drain. The breastbone and chest incision will then be closed.
You will be in the operating room for about six to eight hours.
After surgery you will be taken to the Cardiothoracic Surgical Intensive Care Unit. You will still be asleep and on the breathing machine. As the anesthesia wears off, you will wake up slowly. Once awake, you will be on the breathing machine, but won’t be able to talk. You will be given medications to help with pain and to keep you comfortable and relaxed. Special mechanical boots or sleeves will be placed around your legs to keep blood flowing through them and prevent blood clots.
When you are fully awake and able to breathe on your own, the breathing tube will be removed.
Having some pain after surgery is normal. It is important to let the nurses know if you are in pain so they can give you pain medication. Your nose and throat may be sore because of the breathing and stomach tubes. For most patients, the chest tubes are the most uncomfortable part of the surgery, but this discomfort gets better in a few days.
The tube in your bladder may cause a feeling of pressure on your bladder or make you feel like you have to urinate. This tube is usually taken out after three to four days. After it is taken out, you may have a burning feeling the first few times you urinate.
When you are off the breathing machine and in stable condition, you will be moved out of intensive care and into a room where you can move around more freely while still being monitored. Activity is an important part of recovery after surgery, and you can expect to be getting out of bed as soon as your doctor allows. The types of activities include: sitting in a chair several times a day, walking short distances in the hallways, deep breathing exercises and coughing. Coughing helps reduce the risk of infection in the lungs, such as pneumonia. Although it may be painful at times, coughing will not harm the incision.
The incision will be cleaned daily with mild soap and water, and fresh bandages will be applied to prevent infection.
A dietitian will visit you to make sure you are eating well. Physical therapists will be available to help you with walking and exercise.
Your length of stay in the hospital will depend on how sick you were prior to implantation, how quickly you recover from the surgery, and how long your doctors feel is necessary. The average stay in the hospital is two to six weeks.
How fast you learn to manage your device is also a determining factor.
You and your caregiver will be taught how the MCS device works, and you will have to pass a written test. Daily care and monitoring of the MCS device is the responsibility of you and your caregiver.
Before you can leave the hospital, you and your caregiver must be able to show how to safely operate the MCS device, especially in an emergency situation.
It is imperative to have a dedicated plug that is not connected to a light switch. Cedars-Sinai is not responsible for electrical bills.
After you leave the hospital you will continue getting stronger. For the first eight weeks you will have limits on your everyday activities. For example, you should not lift heavy objects during that period. If you have any problems, your recovery time may be longer, but the MCS team will watch your progress closely.
Your condition will be need to be followed long-term at the MCS clinic or at a designated clinic. Or, if you are waiting for a heart transplant, until the transplant. For the first month, you will be required to come to the clinic once a week. If you are healthy enough and progressing well, your clinic visits will decrease to every other week for a month. Once the doctor decides you are healthy enough and progressing well, you will eventually have fewer clinic visits.
All patients are encouraged to join a cardiac rehabilitation program near their home, or they can enroll in the Preventive and Rehabilitative Cardiac Center at the Smidt Heart Institute.
You will be able to do many of the normal activities you are used to. However, there are restrictions that are important to ensuring your health and safety while you have the device. The MCS team will educate you on the lifestyle changes required for living successfully with a heart pump.
Your doctor may allow you to travel if your condition has remained stable. It is critically important that you speak with the MCS team about any upcoming travel plans so that we may provide you with contact information for a medical facility with an MCS program near your travel destination.
An MCS surgeon, cardiologist and coordinator are on call, 24/7, to answer all your questions and concerns. You will be given the MCS office phone number, your coordinator’s name, office hours, and the after-hours and emergency phone numbers to answer any emergencies. For more information or for non-emergency questions, 310-423-7338.