Insertion of ventricular assist device; extracorporeal, biventricular
CPT4 code
Name of the Procedure:
Insertion of ventricular assist device; extracorporeal, biventricular (also known as Biventricular Assist Device, BiVAD)
Summary
Inserting a biventricular assist device involves installing a mechanical pump that helps both the left and right sides of the heart pump blood. This device is placed outside the body (extracorporeal) and is used in patients with severe heart failure.
Purpose
This procedure addresses severe heart failure, when both ventricles of the heart cannot adequately pump blood. The goal is to support heart function, improve blood flow, and stabilize the patient until a more permanent solution, such as a heart transplant, is available.
Indications
- Severe biventricular heart failure
- Patients awaiting heart transplantation
- Cardiogenic shock
- Failure of conventional heart failure treatments
Preparation
- The patient may need to fast for 8-12 hours before the procedure.
- Discontinuation or adjustment of certain medications may be required.
- Diagnostic tests such as blood tests, echocardiograms, and electrocardiograms (EKGs) will be conducted.
Procedure Description
- The patient is placed under general anesthesia.
- A surgical incision is made in the chest.
- The biventricular assist device is connected to both the left and right ventricles of the heart via cannulae.
- The device, which remains outside the body, is then connected to an external console that controls and monitors its function.
- The incision is closed, and dressings are applied.
Duration
The procedure typically takes 4 to 6 hours.
Setting
The procedure is performed in a hospital operating room equipped with advanced cardiac surgical equipment.
Personnel
- Cardiothoracic surgeons
- Surgical nurses
- Anesthesiologists
- Perfusionists (who manage the heart-lung machine during surgery)
Risks and Complications
- Bleeding
- Infection
- Blood clots
- Device malfunction
- Stroke
- Damage to surrounding organs
Benefits
- Immediate support to both ventricles
- Enhanced blood flow and oxygen delivery to organs
- Stabilization of the patient's condition
- Extension of survival time while awaiting heart transplantation
Recovery
- Patients are typically monitored in the intensive care unit (ICU) post-procedure.
- Pain management and wound care are provided.
- Gradual increase in activity as tolerated.
- Regular follow-up appointments to monitor device function and overall health.
- Recovery time varies but may take several weeks.
Alternatives
- Left ventricular assist device (LVAD) for less severe cases
- Total artificial heart
- Medical management with medications
- Heart transplantation (if a suitable donor is available)
Patient Experience
- During the procedure: The patient will be under general anesthesia and should not feel anything.
- After the procedure: The patient may experience discomfort or pain at the incision site, which can be managed with medications. The sensation of the device working externally may also require some adjustment.
- Pain management and support will be provided to ensure comfort during recovery.