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

1. The patient is placed under general anesthesia.
2. An incision is made at the site of the original VAD implantation.
3. Surgical removal of the VAD is carefully performed, ensuring minimal impact on surrounding heart and vascular structures.
4. Repair and closure of the heart and blood vessels are carried out as needed.
5. 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.