33993 Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion

Name of the Procedure:

Repositioning of Percutaneous Right or Left Heart Ventricular Assist Device (VAD) with Imaging Guidance.

Summary

This procedure involves adjusting the position of a ventricular assist device (VAD) that is already in place. The adjustment is guided by imaging techniques to ensure precise placement, performed at a separate time from the original insertion.

Purpose

The purpose of this procedure is to correct the positioning of a VAD, which supports heart function in patients with severe heart failure. Proper positioning ensures optimal device performance and minimizes complications, enhancing the patient's cardiac output and overall health.

Indications

• Malposition or migration of the VAD.
• Suboptimal performance of the VAD.
• New or worsening symptoms of heart failure.
• Imaging evidence suggesting misplacement of the device.

Preparation

• The patient may be required to fast for several hours before the procedure.
• Medication adjustments might be necessary, especially if blood thinners are being taken.
• Pre-procedure imaging studies, such as an echocardiogram or CT scan, to evaluate the current position of the VAD.

Procedure Description

1. The patient is positioned appropriately on the procedure table.
2. Imaging equipment, such as fluoroscopy or ultrasound, is set up and used to guide the procedure.
3. Local anesthesia or sedation is administered to ensure patient comfort.
4. The VAD is accessed percutaneously through the existing entry point.
5. Using real-time imaging, the healthcare provider carefully repositions the VAD into the correct position.
6. Imaging is used again to confirm the optimal placement of the VAD.
7. The site is monitored and closed appropriately, and the patient is observed for any immediate complications.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity.

Setting

This procedure is usually performed in a hospital, particularly in a specialized cardiac catheterization lab or an operating room equipped with advanced imaging technology.

Personnel

• Cardiologist or cardiothoracic surgeon
• Interventional radiologist
• Anesthesiologist or sedation team
• Nursing staff specialized in cardiac care

Risks and Complications

• Infection at the access site
• Bleeding or hematoma formation
• Damage to the heart or blood vessels
• Device malfunction or failure
• Adverse reaction to anesthesia or sedation
• Rarely, stroke or heart attack

Benefits

• Improved functioning of the VAD
• Enhanced cardiac output and symptomatic relief
• Minimized complications related to device malposition
• Improved overall quality of life

Recovery

• Patients may need to stay in the hospital for observation for 24-48 hours.
• Post-procedure care includes monitoring vital signs and device function.
• Restrictions on physical activity may apply for a short period.
• Follow-up appointments for imaging and device assessment are essential.

Alternatives

• Medical management with medications and lifestyle changes.
• Re-insertion of a new VAD if repositioning is not feasible or successful.
• Heart transplantation in eligible patients.

Each alternative has its pros and cons, such as less invasiveness for medical management versus the greater long-term efficacy of VAD repositioning.

Patient Experience

During the procedure, the patient will receive sedation or anesthesia to minimize discomfort. Post-procedure, there may be minor soreness at the access site. Pain management will be provided, and most patients can return to light activities within a few days to a week. The experience involves thorough follow-up to ensure the VAD is functioning properly and to monitor for any complications.