Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion
CPT4 code
Name of the Procedure:
Removal of Percutaneous Left Heart Ventricular Assist Device (LVAD), Arterial or Arterial and Venous Cannula(s) at Separate and Distinct Session from Insertion
Summary
This procedure involves the removal of a left heart ventricular assist device (LVAD) cannula, which was previously inserted to help support heart function. The cannula can be either arterial or both arterial and venous. This removal occurs during a separate session from the initial insertion.
Purpose
The procedure is performed when the patient's heart function has improved enough that the LVAD is no longer needed for mechanical support. The goal is to safely and efficiently remove the device components to reduce the risk of infection and other complications.
Indications
- Improvement in cardiac function
- Resolution of the acute condition that necessitated LVAD support
- Patient meeting specific clinical criteria for device removal
Preparation
- Fasting for several hours prior to the procedure
- Adjustment or temporary discontinuation of certain medications
- Pre-procedure blood tests and imaging studies to assess heart function
Procedure Description
- The patient is positioned and prepared in a sterile environment.
- Local or general anesthesia is administered.
- The incision site is carefully reopened.
- The LVAD cannulas (arterial or arterial and venous) are located.
- The devices are carefully removed, ensuring minimal disruption to surrounding tissues.
- The incision site is then cleaned and sutured closed.
- Pressure dressings are applied to prevent bleeding.
Duration
The procedure typically takes 1-2 hours.
Setting
The procedure is usually performed in an operating room within a hospital.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (if needed)
Risks and Complications
- Infection at the incision site
- Bleeding
- Blood clots
- Injury to adjacent structures
- Recurrent cardiac issues
Benefits
- Elimination of the need for mechanical heart support
- Reduced risk of device-related infections
- Improved mobility and quality of life
- Quick realization of benefits post-procedure as the body adapts to independent cardiac function
Recovery
- Monitoring in a recovery room for several hours post-procedure
- Observation in the hospital for 1-2 days
- Antibiotic therapy to prevent infection
- Gradual return to normal activities over a few weeks
- Follow-up appointments to monitor heart function and incision healing
Alternatives
- Continued LVAD support if heart function remains compromised
- Heart transplant in cases of severe heart failure
- The decision between alternatives depends on overall patient health, severity of cardiac dysfunction, and medical advice.
Patient Experience
Patients may experience mild discomfort at the incision site post-procedure, manageable with pain medication. Some may feel anxious or relieved about the removal, and healthcare providers can offer support and counseling. Overall, the experience is geared towards improving the patient's quality of life by restoring autonomous heart function.