Name of the Procedure:

Removal of Ventricular Assist Device (VAD); Extracorporeal, Single Ventricle

Summary

This procedure involves the surgical removal of a ventricular assist device (VAD) that supports a single ventricle of the heart. A VAD is a mechanical pump that assists heart function and blood flow, usually implanted in patients with severe heart failure. The removal process is a complex surgery performed after the heart has regained sufficient strength or when transitioning to a heart transplant.

Purpose

Condition Addressed: Heart failure requiring mechanical support by a VAD.

Goals/Expected Outcomes: The primary goal is to safely remove the VAD when it is no longer needed. This can be due to significant recovery of heart function, successful heart transplant, or complications related to the device itself.

Indications

Symptoms/Conditions:

• Successful heart transplant requiring VAD removal.
• Significant improvement in heart function.
• Complications associated with the VAD, such as infection or device failure.

Patient Criteria:

• Stable cardiac function demonstrated through diagnostic testing.
• No contraindications for surgery.

Preparation

Pre-procedure Instructions:

• Fasting for at least 8 hours before surgery.
• Medication adjustments as instructed by the physician, including anticoagulants.
• Pre-surgical washing and adherence to hygiene protocols.

Diagnostic Tests/Assessments:

• Cardiac MRI or echocardiogram to assess heart function.
• Blood tests to evaluate overall health.
• Pre-anesthetic evaluation.

Procedure Description

1. Anesthesia:
   • General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision:
   • An incision is made in the chest to access the heart and the VAD.
3. Device Disconnection:
   • The VAD is carefully dissected from the heart and blood vessels.
4. Heart and Vessel Repair:
   • Any incisions or connections made for the VAD are repaired to restore normal heart anatomy and function.
5. Closure:
   • The chest incision is closed using sutures or staples, and sterile dressings are applied.

Tools and Equipment:

• Standard surgical instruments, cardiopulmonary bypass machine, monitoring equipment.

Duration

The procedure typically lasts between 3 to 6 hours, depending on the complexity and patient condition.

Setting

Performed in a hospital setting, specifically in a cardiac surgery operating room.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (if cardiopulmonary bypass is used)
• Surgical Technicians

Risks and Complications

Common Risks:

• Infection
• Bleeding or hematoma
• Pain and discomfort at the surgical site

Rare Complications:

• Heart arrhythmias
• Stroke or other thromboembolic events
• Organ failure (kidneys, liver)

Management:

• Post-operative care in ICU, close monitoring, and immediate intervention for complications.

Benefits

Expected Benefits:

• Removal of the VAD can potentially lead to improved quality of life.
• Elimination of the risks associated with long-term VAD use.
• Gradual return to normal or near-normal heart function.

Recovery

Post-procedure Care:

• Close cardiac monitoring in the Intensive Care Unit (ICU).
• Pain management with medications.
• Gradual reintroduction of normal activities.

Expected Recovery Time:

• Initial hospital recovery typically takes 1-2 weeks.
• Full recovery can take several months, with follow-up appointments to monitor heart function and overall health.

Alternatives

Other Treatment Options:

• Continued VAD support with regular monitoring and management.
• Heart transplant, if not already done.

Pros and Cons of Alternatives:

• Continued VAD support requires frequent monitoring and comes with risks of infection and mechanical failure.
• Heart transplant may offer a long-term solution, but involves risks of rejection and need for lifelong immunosuppressive therapy.

Patient Experience

During the Procedure:

• The patient will be under general anesthesia and will not feel anything during the surgery.

After the Procedure:

• Post-operative pain that will be managed with medications.
• Initial discomfort at the incision site, eventual improvement over time.
• Emotional and physical support from healthcare professionals to assist in recovery.