Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only
CPT4 code
Name of the Procedure:
Insertion of Ventricular Assist Device (VAD), Percutaneous, with Radiological Supervision and Interpretation; Left Heart, Arterial Access Only.
Summary
This procedure involves the placement of a ventricular assist device (VAD) in the left heart through a small incision in the artery. It is performed under radiological guidance to ensure precise placement. The VAD helps the heart pump blood more effectively.
Purpose
This procedure addresses severe left heart failure, where the heart cannot pump blood adequately to meet the body's needs. The goal is to improve blood flow, reduce symptoms, and enhance the quality of life.
Indications
- Severe left ventricular heart failure that is not responsive to medication
- Bridge to heart transplant or long-term therapy
- Cardiogenic shock
- Poor cardiac output leading to organ failure
Preparation
- Fasting for at least 8 hours before the procedure
- Adjustment or discontinuation of certain medications (e.g., blood thinners)
- Pre-procedure diagnostic tests such as an echocardiogram, blood tests, and possibly a cardiac catheterization
Procedure Description
- The patient is given local anesthesia and sedatives.
- An incision is made in the artery, usually in the groin area.
- A catheter is inserted and guided to the left heart with the aid of fluoroscopy (X-ray imaging).
- The VAD is then threaded through the catheter and positioned in the left ventricle.
- The device is activated to assist with pumping blood.
- Radiological imaging confirms the correct placement.
- The incision is closed and bandaged.
Duration
The procedure typically takes 2-4 hours.
Setting
The procedure is performed in a hospital, specifically in the cardiac catheterization lab or a hybrid operating room equipped for radiological imaging and surgical procedures.
Personnel
- Interventional cardiologist or cardiac surgeon
- Radiologist
- Anesthesiologist
- Cardiac nurse or technician
Risks and Complications
- Bleeding or bruising at the insertion site
- Infection
- Blood clots or stroke
- Mechanical failure or malfunction of the device
- Vascular complications
- Need for additional surgeries
Benefits
- Improved cardiac output and blood flow
- Relief from symptoms of heart failure
- Enhanced quality of life
- Potential bridge to heart transplant or long-term cardiac support
Recovery
- Initial recovery in the intensive care unit (ICU) for close monitoring
- Gradual transition to a regular hospital room
- Pain management with medications
- Instructions for wound care at the insertion site
- Activity restrictions and gradual return to normal activities
- Follow-up appointments to monitor device function and overall health
Alternatives
- Medical management with medications and lifestyle changes
- Heart transplant for eligible patients
- Other mechanical circulatory support devices or procedures
- Palliative care for symptom management without aggressive interventions
Patient Experience
- Mild discomfort or pressure during the insertion
- Post-procedure soreness at the incision site
- Possible anxiety or stress, managed with sedatives or support from healthcare staff
- Continuous monitoring and support from the medical team to ensure comfort and proper device function