33368 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure

Name of the Procedure:

Transcatheter Aortic Valve Replacement (TAVR/TAVI) with Prosthetic Valve; Cardiopulmonary Bypass Support with Open Peripheral Arterial and Venous Cannulation (e.g., femoral, iliac, axillary vessels)

Summary

Transcatheter Aortic Valve Replacement (TAVR/TAVI) is a minimally invasive procedure used to replace a narrowed aortic valve that fails to open properly. It includes cardiopulmonary bypass support with the insertion of cannulas (tubes) into peripheral arteries and veins, such as the femoral or axillary vessels, to maintain blood flow during the procedure.

Purpose

This procedure addresses severe aortic stenosis, a condition where the aortic valve becomes narrowed, leading to reduced blood flow from the heart. The goal is to replace the faulty valve with a new prosthetic valve to improve blood flow and relieve symptoms associated with the condition.

Indications

• Severe aortic stenosis causing symptoms such as chest pain, shortness of breath, or fainting
• High or prohibitive surgical risk patients for traditional open-heart valve replacement
• Patients with comorbid conditions that make traditional surgery too risky

Preparation

• Pre-procedure instructions typically include fasting the night before.
• Patients may need to adjust their medications under doctor's advice.
• A series of diagnostic tests, including echocardiograms, CT scans, and blood tests, are conducted to assess the heart and overall health.

Procedure Description

1. The patient is given general anesthesia.
2. The surgeon makes a small incision to access the femoral, iliac, or axillary vessels and inserts cannulas.
3. Cardiopulmonary bypass is initiated to maintain circulation and oxygenation during the procedure.
4. A catheter with a compressed prosthetic valve is threaded through the blood vessels to the aortic valve.
5. The new valve is expanded, pushing the old, faulty valve aside, and takes over its function.
6. The catheter is then removed, and the incisions are closed.

Duration

The procedure typically takes 2 to 4 hours to complete.

Setting

The procedure is performed in a hospital's cardiac catheterization lab or operating room.

Personnel

• Interventional cardiologist or cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Perfusionist (specialist managing the cardiopulmonary bypass machine)

Risks and Complications

• Bleeding or infection at the cannulation site
• Stroke or heart attack
• Damage to the blood vessels
• Valve leakage or malfunction
• Kidney damage

Benefits

• Relief of symptoms such as chest pain and shortness of breath
• Improved quality of life and physical activity levels
• Reduced risk of life-threatening complications from severe aortic stenosis

Recovery

• Patients are typically monitored in an intensive care unit for a day or two.
• Hospital stay ranges from 3 to 7 days.
• Post-procedure instructions include activity restrictions and follow-up appointments.
• Full recovery can take a few weeks to a couple of months.

Alternatives

• Surgical Aortic Valve Replacement (SAVR): Traditional open-heart surgery, more invasive with a longer recovery.
• Medical management: Medications to manage symptoms, but not a long-term solution.
• Balloon aortic valvuloplasty: A temporary measure where a balloon is used to widen the narrowed valve.

Patient Experience

Patients can expect some discomfort at the cannulation sites and general tiredness. Pain management includes prescribed medications and comfort measures. Regular follow-ups ensure proper healing and monitor the function of the new valve.