Name of the Procedure:

Insertion of Ventricular Assist Device (VAD), percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture.

Summary

This procedure involves the percutaneous (through the skin) insertion of a left ventricular assist device (LVAD) to help the left side of the heart pump blood. It utilizes guided imaging techniques for precise placement and requires access through both arterial and venous routes with a puncture through the septum of the heart.

Purpose

The procedure is designed to support the left ventricle of the heart in pumping blood for patients with severe heart failure or cardiogenic shock. The goal is to improve cardiac output and stabilize the patient's condition.

Indications

• Severe left-sided heart failure
• Cardiogenic shock that is unresponsive to medical management
• Bridge to heart transplantation or recovery
• Patients with acute myocardial infarction leading to profound heart failure

Preparation

• Patients may be required to fast for several hours before the procedure.
• Adjustments to current medications may be necessary, including anticoagulants.
• Pre-procedure diagnostic tests include blood work, echocardiography, and potentially a cardiac MRI or CT scan.

Procedure Description

1. The patient is positioned on the procedure table, and local anesthesia or general anesthesia is administered.
2. Access points are established in both an artery and a vein, typically in the groin.
3. A catheter is threaded through the veins into the heart, where a transseptal puncture is performed to access the left atrium.
4. The ventricular assist device is then advanced and correctly positioned in the left ventricle using fluoroscopic guidance.
5. Radiological supervision ensures precise placement and functionality of the device.
6. Once in place, the VAD is activated to assist with blood circulation.
7. The access sites are closed and dressed.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the case.

Setting

This procedure is performed in a hospital setting, specifically in a cardiac catheterization laboratory or an operating room equipped with radiological imaging facilities.

Personnel

• Interventional cardiologist or cardiac surgeon
• Anesthesiologist
• Radiologist
• Nursing staff specialized in cardiac care
• Technicians for imaging and device operation

Risks and Complications

• Bleeding at the access site
• Infection
• Blood clots or stroke
• Device malfunction or failure
• Puncture-related complications such as cardiac tamponade
• Reaction to anesthesia

Benefits

• Improved cardiac output and stabilization of cardiac function
• Potential for recovery of heart function or successful heart transplantation
• Alleviation of symptoms of heart failure

Recovery

• Close monitoring in the ICU post-procedure
• Instructions on wound care at the access sites
• Gradual return to physical activity as advised by the healthcare team
• Regular follow-up appointments to monitor device function and heart health

Alternatives

• Medical management with medications
• Other forms of mechanical circulatory support (e.g., intra-aortic balloon pump)
• Heart transplantation
• Risks and benefits of alternatives vary and should be discussed with a healthcare provider.

Patient Experience

During the procedure, patients under local anesthesia may feel some pressure or discomfort at the access site, while those under general anesthesia will be asleep. Post-procedure, patients may experience soreness at the insertion sites and tiredness. Pain management includes medications and comfort measures to ensure a smooth recovery.