Removal of ventricular assist device; extracorporeal, biventricular
CPT4 code
Name of the Procedure:
Removal of Ventricular Assist Device (VAD); Extracorporeal, Biventricular
Summary
The procedure involves the surgical removal of an external ventricular assist device (VAD) that supports both the left and right ventricles of the heart. This device is often used temporarily for patients awaiting heart transplants or recovering from heart surgery.
Purpose
The procedure addresses patients who no longer need the mechanical support of a VAD due to recovery or after receiving a heart transplant. The goal is to safely remove the device and allow the patient's heart or a heart transplant to function independently.
Indications
- Recovery of heart function making the VAD unnecessary
- Successful heart transplantation
- Complications or infections related to the VAD
- Mechanical failure of the device
Preparation
- Fasting 8 hours before surgery
- Adjustment or discontinuation of certain medications (e.g., blood thinners)
- Pre-operative assessments, including blood tests, imaging studies, and heart function tests
- Ensuring existing infections are managed
Procedure Description
- Anesthesia is administered to ensure the patient is fully unconscious and pain-free.
- Surgical disinfection and sterile draping of the area.
- Incisions are made to access the device and its connections to the heart and blood vessels.
- Carefully detaching the device from the heart and blood vessels, taking precautions to maintain cardiovascular stability.
- Closure of blood vessels and heart tissue, ensuring no bleeding or leaks.
- Surgical closure of the incision site and sterilization of the area.
Duration
Typically takes 2 to 4 hours, depending on the complexity and patient condition.
Setting
Performed in a hospital operating room under strict sterile and monitored conditions.
Personnel
- Cardiothoracic Surgeon
- Surgical Nurses
- Anesthesiologist
- Perfusionist (if heart-lung bypass is needed)
- Cardiologist (for intra-operative monitoring)
Risks and Complications
- Infection
- Bleeding or blood clots
- Heart rhythm problems
- Stroke or other neurological events
- Complications from anesthesia
- Vascular complications (e.g., vessel damage)
Benefits
- Ability to transition to heart transplant or independence from mechanical support
- Improved quality of life
- Reduced risk of long-term complications from the device
- Restoration of natural heart function in the case of recovery
Recovery
- Intensive care monitoring immediately post-operation
- Gradual re-introduction to activities over several weeks
- Pain management and wound care
- Regular follow-up appointments to monitor heart function and recovery
- Avoiding strenuous activities and heavy lifting for 4-6 weeks
Alternatives
- Continued use of the VAD
- Heart transplant (if not already performed)
- Medical management of heart condition
Patient Experience
Patients will be under general anesthesia, so they won't feel or be aware of the procedure itself. Post-procedure, patients may experience discomfort, pain at the incision site, and some fatigue. Pain will be managed with medications, and assistance will be provided for mobility and daily activities. Regular follow-up and gradual increase in activity will be part of the recovery process.