Removal of ventricular assist device, implantable intracorporeal, single ventricle
CPT4 code
Name of the Procedure:
Removal of Ventricular Assist Device (VAD), Implantable Intracorporeal, Single Ventricle
Summary
The removal of a ventricular assist device (VAD) is a surgical procedure where a previously implanted mechanical pump, used to support heart function and blood flow in individuals with weakened hearts, is taken out. This procedure specifically addresses devices aiding a single ventricle.
Purpose
The primary purpose of this procedure is to remove the VAD when it is no longer needed. This could be due to heart recovery, a need for heart transplantation, VAD-related complications, or a device failure.
Indications
- Recovery of the heart's functionality allowing it to pump blood adequately without assistance.
- Arranged for a heart transplant.
- Infection or complications related to the VAD.
- Malfunction or failure of the VAD.
Preparation
- Patients are required to fast for 8-12 hours prior to the procedure.
- Preoperative assessments including blood tests, ECG, chest X-ray, and echocardiogram.
- Medication adjustments as directed by the physician, particularly for blood thinners.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made at the site of the original VAD implantation.
- Surgical removal of the VAD is carefully performed, ensuring minimal impact on surrounding heart and vascular structures.
- Repair and closure of the heart and blood vessels are carried out as needed.
- The incision is closed, and the area is dressed.
The use of surgical tools such as scalpels, retractors, and sutures is integral, and a cardiopulmonary bypass machine may be employed to take over heart function temporarily.
Duration
The procedure typically takes 3-6 hours, varying with potential complications and the patient’s condition.
Setting
This procedure is performed in a hospital’s surgical suite, equipped with specialized machinery for cardiac surgeries.
Personnel
- Cardiothoracic surgeons
- Anesthesiologists
- Surgical nurses
- Perfusionists
- Intensive care team for postoperative care
Risks and Complications
- Infection
- Bleeding
- Stroke
- Arrhythmias (abnormal heart rhythms)
- Heart failure
- Blood clots
Benefits
- Removal of unnecessary mechanical support, allowing natural heart function.
- Reduced risk of VAD-related complications.
- Potentially improved quality of life.
Recovery
- Hospital stay for monitoring usually lasts 7-10 days post-surgery.
- Gradual return to normal activities over 4-6 weeks.
- Regular follow-up appointments for monitoring heart function and overall recovery.
- Possible physical therapy and cardiac rehabilitation.
Alternatives
- Long-term VAD support, if heart does not recover or patient is not eligible for transplantation.
- Heart transplantation.
- Palliative care for managing symptoms without VAD support.
Patient Experience
During the procedure, the patient will not feel discomfort due to general anesthesia. Post-procedure, they may experience pain or soreness at the incision site, managed with pain relief medications. Fatigue and general weakness are common, with slow but steady improvement expected as recovery progresses.