33975 Insertion of ventricular assist device; extracorporeal, single ventricle

Name of the Procedure:

Insertion of Ventricular Assist Device (VAD); Extracorporeal, Single Ventricle
Common name(s): VAD placement, Single VAD placement

Summary

An extracorporeal ventricular assist device (VAD) helps the heart pump blood when it is unable to do so effectively on its own. In this procedure, a mechanical pump is connected to a single ventricle of the heart (either the left or right) and positioned outside the body to assist in blood circulation.

Purpose

This procedure is primarily used to support individuals with severe heart failure. The goal is to improve blood flow and oxygen delivery to the body's tissues, thereby relieving symptoms of heart failure and enhancing the patient’s quality of life. It can also serve as a bridge to heart transplant or as a longer-term therapy.

Indications

• Severe heart failure unresponsive to medical therapy
• Cardiogenic shock
• Patients awaiting heart transplant (bridge to transplant)
• Severe ventricular dysfunction

Preparation

• Pre-procedure fasting for 8-12 hours
• Adjustment or cessation of certain medications (e.g., anticoagulants)
• Comprehensive diagnostic tests, including ECG, echocardiogram, blood tests, and sometimes cardiac catheterization
• Patient education and informed consent

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made near the chest or abdomen, depending on the specific approach.
3. Cannulation: Cannulas (tubes) are inserted into the heart chambers and major blood vessels.
4. Device Connection: The VAD is positioned outside the body and connected to the heart via the cannulas.
5. Device Activation: The device is activated to begin assisting in blood circulation.
6. Closure: The incision is closed, and the patient is monitored in the intensive care unit (ICU).

Duration

The procedure typically takes 4-6 hours.

Setting

Performed in a hospital operating room with an intensive care unit (ICU) for postoperative care.

Personnel

• Cardiac surgeon
• Surgical nurses
• Anesthesiologist
• Perfusionist (a specialist in operating heart-lung machines)
• Intensive care team

Risks and Complications

• Infection at the incision sites
• Blood clots leading to stroke
• Device malfunction or failure
• Right heart failure (if a left VAD is placed)
• Bleeding complications
• Organ dysfunction

Benefits

• Improved blood circulation and oxygenation
• Relief from symptoms of heart failure
• Enhanced quality of life
• Extension of life expectancy, especially when awaiting a heart transplant

Recovery

• ICU stay for close monitoring and initial recovery (several days to weeks)
• Gradual physical rehabilitation and cardiac monitoring
• Lifelong follow-up appointments to ensure device functionality and manage complications
• Possible restrictions on physical activities and dietary adjustments

Alternatives

• Medical therapy optimization (e.g., medications, lifestyle changes)
• Other types of mechanical circulatory support (e.g., intra-aortic balloon pump)
• Heart transplant (for eligible candidates)
• Palliative care in advanced cases

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware of the surgery. Postoperatively, patients might experience discomfort at the incision site and general fatigue. Pain management, including medications and supportive care, will be implemented to ensure comfort. Recovery includes close monitoring and gradual return to daily activities over several weeks.