Name of the Procedure:

Insertion of Ventricular Assist Device, Percutaneous, including Radiological Supervision and Interpretation; Right Heart, Venous Access Only
Common name: Right Heart VAD Insertion
Technical/medical term: Right Ventricular Assist Device (RVAD) Insertion

Summary

This procedure involves placing a ventricular assist device (VAD) into the right ventricle of the heart through venous access. It helps the heart pump blood and is guided using radiological imaging.

Purpose

This procedure is used for patients with severe right ventricular heart failure. The goal is to support the heart's function, improve blood circulation, and alleviate symptoms of heart failure.

Indications

• Severe right ventricular heart failure
• Cardiogenic shock
• Pulmonary hypertension with right heart failure
• Certain patients awaiting heart transplant

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Blood tests, ECG, and imaging studies like echocardiograms may be required.
• Medication adjustments, including anticoagulants, may be necessary.

Procedure Description

1. The patient is administered local anesthesia and conscious sedation or general anesthesia.
2. A catheter is inserted into a vein, typically in the groin.
3. Radiological imaging guides the catheter to the right ventricle of the heart.
4. The VAD is then positioned correctly and secured.
5. Radiological supervision ensures proper placement and functioning of the device.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital's cardiac catheterization lab or operating room.

Personnel

• Interventional cardiologist or cardiac surgeon
• Radiologist
• Anesthesiologist or anesthesia nurse
• Cardiac nurses and technicians

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma
• Vascular injury
• Device malfunction or displacement
• Blood clots
• Arrhythmias
• Allergic reaction to contrast dye

Benefits

• Improved heart function and blood circulation
• Relief of symptoms associated with right heart failure
• Stabilization of the patient’s condition while waiting for a heart transplant

Recovery

• Close monitoring in an intensive care unit (ICU) post-procedure
• Regular assessments and imaging tests to ensure device functionality
• Physical activity may be limited initially
• Follow-up appointments to monitor progress and make necessary adjustments

Alternatives

• Medications such as inotropes or diuretics
• Mechanical circulatory support like intra-aortic balloon pump (IABP)
• Heart transplant for eligible patients
• Considerations of pros and cons of less invasive treatments versus immediate benefits from VAD

Patient Experience

During the procedure, the patient may feel some discomfort or pressure during catheter insertion. Post-procedure, discomfort at the insertion site and mild pain are managed with medications. The majority of patients notice significant improvement in symptoms soon after recovery from the procedure.