The central element of the EXCOR® ventricular assist device is the blood pump. It consists of a blood chamber and an air chamber, which are separated by a triple-layer membrane. A pneumatic drive alternately pumps air, through a tube, into and out of the blood pump's air chamber. As a result, the membrane moves in a pulsating manner. This causes the blood to be pumped through cannulae out of the body, into the blood-carrying side of the pump, and back into the body. Similarly to the heart, the EXCOR® blood pump possesses valves.
These ensure that the blood can only flow in one direction. Here, the pump rate can be adjusted to the individual requirements of the patient. In adolescents and adults, the Ikus stationary driving unit is replaced by the Excor mobile as soon as the patient is stable. With this system, patients are largely able to move freely and can be discharged to their homes.
The EXCOR® is implanted using standardized surgical techniques and a cardiopulmonary bypass machine. The CPB machine takes over the circulation and oxygenation of the blood while the EXCOR® cannulae are connected to the heart and blood vessels. After the cannulae have been tunneled through the skin, the surgeon connects the cannulae to the EXCOR® blood pump. The VAD team adjusts the pump rate and the pump pressures via the Ikus stationary driving unit. This ensures an optimal blood pump function. At the same time, the patient is gradually weaned from the CPB machine and the EXCOR® VAD takes over the total pump output.
After implantation, the patient receives care in the intensive care unit. Experienced ICU doctors and nurses closely examine the patient and conduct lab tests. This is followed by stationary care. Depending on the initial condition, it may take a few weeks for the body to recover. Doctors regularly check the transcutaneous exit site of the cannulae, keep it clean, and place sterile wound dressings over it in order to support a fast healing process. The function of the ventricular assist device is continuously monitored. In order to prevent the formation of blood clots (deposits), the patient takes anticoagulants (drugs that inhibit coagulation) from this point on. It is also important to follow a healthy diet. To this end, the hospital team creates an individualized diet plan. As soon as the patient's condition becomes stable, the Ikus stationary driving unit can be replaced by Excor mobile if needed.
Note: The therapy descriptions presented here are only illustrative and may vary from patient to patient. If you have questions regarding your individual condition and therapy options, please talk to your treating physician.
Following training on dressing changes for the transcutaneous exit sites and on general handling of the VAD, discharge is possible depending on the patient's condition. Before discharge, the VAD team explains to patients and their families such things as:
A mandatory prerequisite for discharge is that the person feels confident when handling the VAD. After discharge, the patient visits the hospital's outpatient clinic only for routine checkups. If required, the hospital VAD team is available at all times. The postoperative care and wound care do not have to be conducted at the implantation hospital. These can basically also be conducted at a hospital that is local to the patient.
The mobile drive of the EXCOR® creates good conditions for the patient to successfully navigate everyday life at home. Despite unavoidable limitations, the patient is soon able to perform his earlier tasks and take part in recreational activities. If physician and employer are in agreement, the patient may even go back to work.
In order to accelerate the recovery process, movement is also important. The treating physician can recommend a few suitable activities that can accelerate the recovery process.
And personal care?
When the transcutaneous exit sites of the cannulae have healed, the patient will be able to shower or at least to shower individual body regions, under certain conditions. The EXCOR® system must be switched to battery operation beforehand, every single time. All external parts must be protected from splashing water.