33548 Surgical ventricular restoration procedure, includes prosthetic patch, when performed (eg, ventricular remodeling, SVR, SAVER, Dor procedures)

Name of the Procedure:

Surgical Ventricular Restoration (SVR), also known as Surgical Ventricular Remodeling or Dor Procedure.

Summary

Surgical Ventricular Restoration (SVR) is a heart surgery aimed at improving the shape and function of the heart's left ventricle. The procedure often involves the placement of a prosthetic patch to help repair and reshape the ventricle, improving its ability to pump blood effectively.

Purpose

SVR is designed to treat heart failure and other complications resulting from a heart attack or other cardiac conditions that have caused the left ventricle to become enlarged or misshapen. The primary goal is to improve the heart's function and reduce symptoms like shortness of breath, fatigue, and chest pain.

Indications

• Heart failure with symptoms not responding to other treatments.
• Enlarged or misshapen left ventricle due to a previous heart attack.
• Decreased left ventricular function detected through imaging studies.
• Persistent symptoms like severe shortness of breath, fatigue, or chest pain despite medical therapy.

Preparation

• Patients are typically required to fast for 8-12 hours before the surgery.
• Preoperative tests, including blood work, electrocardiogram (ECG), echocardiogram, and possibly cardiac catheterization, are performed to assess heart function.
• Medications may need to be adjusted or temporarily stopped under physician guidance.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made in the chest to access the heart.
3. Heart-Lung Machine: The patient is connected to a heart-lung machine to maintain circulation and oxygenation during the surgery.
4. Restoration: The surgeon trims and reinforces the walls of the left ventricle, often using a prosthetic patch to remodel the shape of the ventricle and improve its function.
5. Closure: The incision is closed with stitches or staples, and the heart-lung machine is gradually weaned off as the heart takes over pumping.

Duration

The procedure typically takes between 3 to 5 hours.

Setting

This surgery is performed in a hospital operating room with specialized cardiac surgical facilities.

Personnel

• Cardiothoracic surgeon
• Surgical assistants
• Anesthesiologist
• Perfusionist (operates the heart-lung machine)
• Operating room nurses

Risks and Complications

• Bleeding
• Infection
• Arrhythmias (irregular heartbeats)
• Stroke
• Temporary or permanent heart failure
• Complications from anesthesia

Benefits

• Improved heart function
• Reduced symptoms like shortness of breath and fatigue
• Enhanced quality of life and physical capabilities
• Potential reduction in hospitalizations for heart failure

Recovery

• Initial hospital stay of 5-10 days, including time in the intensive care unit (ICU).
• Pain management with medications.
• Restrictions on physical activity for several weeks to allow proper healing.
• Follow-up appointments for monitoring heart function and recovery progress.
• Cardiac rehabilitation may be recommended to support recovery and improve heart health.

Alternatives

• Medical management with medications to control heart failure symptoms.
• Implantable devices like a pacemaker or defibrillator.
• Heart transplant in severe cases.
• Percutaneous interventions for less invasive therapy, although not as effective in some cases as SVR.

Patient Experience

• During the procedure: The patient will be asleep under general anesthesia and will not feel pain.
• After the procedure: Pain around the incision site is common, managed with medications.
• The patient may experience fatigue and weakness during the initial recovery period but should see progressive improvement in symptoms and activity levels over weeks to months.

Pain management strategies and supportive care ensure patient comfort during recovery.