93750 Interrogation of ventricular assist device (VAD), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum sta

Name of the Procedure:

Interrogation of Ventricular Assist Device (VAD), also referred to as VAD Check or VAD Assessment.

Summary

This is an in-person procedure where a healthcare professional, typically a physician, examines and evaluates the functioning of a Ventricular Assist Device (VAD). The process involves reviewing device parameters, such as drivelines, alarms, and power surges, and assessing the device’s overall function, including flow, volume status, and septum status.

Purpose

Medical Condition or Problem Addressed:

• Heart failure or severe cardiac conditions where the heart cannot pump blood effectively.

Goals:

• To ensure that the VAD is operating correctly and to detect any potential issues early.
• To optimize device settings for better patient outcomes.
• To prevent complications related to device malfunction.

Indications

Specific Symptoms/Conditions:

• Patients with implanted VADs.
• Symptoms of VAD malfunction, such as decreased flow, unusual alarms, or changes in power usage.
• Routine follow-up for patients with VADs.

Patient Criteria:

• Any patient who has a VAD implanted, either as a bridge to heart transplant or as destination therapy in end-stage heart failure.

Preparation

Pre-procedure Instructions:

• Generally, no specific preparation is required.
• Patients should inform their healthcare provider of any new symptoms or changes in their condition.
• Bring any device-related documentation or logs maintained at home.

Diagnostic Tests:

• Recent blood work or imaging tests may be reviewed before the procedure.

Procedure Description

Steps:

1. The patient arrives at the clinic or hospital.
2. The healthcare professional conducts a preliminary examination and takes a medical history.
3. The VAD's external components, including drivelines, are physically inspected.
4. The healthcare professional connects to the VAD system using a specialized computer interface to download and analyze device parameters such as flow, volume, power usage, and alarms.
5. Adjustments to device settings may be made based on the analysis.
6. A thorough review of the patient’s clinical status, including signs of heart function and overall well-being.
7. Discussion of findings and any required changes in care with the patient.

Tools/Equipment:

• VAD-specific diagnostic computer interface.
• Standard clinical examination tools.

Anesthesia or Sedation:

• Not required.

Duration

Typically takes 30 minutes to 1 hour.

Setting

Performed in a hospital, outpatient clinic, or a specialized VAD center.

Personnel

• Cardiologist or a specially trained physician.
• Cardiac nurse or VAD coordinator.

Risks and Complications

Common Risks:

• Minimal; mainly related to interference with device settings or temporary discomfort.

Rare Risks:

• Device malfunction due to improper handling during the interrogation.
• Infection at driveline site if not properly managed.

Management:

• Immediate recalibration or adjustments by the healthcare provider.
• Appropriate measures for infection prevention or treatment.

Benefits

Expected Benefits:

• Assurance that the VAD is functioning correctly.
• Early detection and correction of potential issues.
• Improved heart function and patient quality of life.

Realization Timeline:

• Immediate evaluation and corrections provide quick peace of mind and functional improvements.

Recovery

Post-procedure Care:

• Patients can generally resume normal activities immediately.
• Follow any specific recommendations provided by the healthcare professional.

Recovery Time:

• None required.

Restrictions/Follow-up:

• Routine follow-up visits as recommended, often every few months.

Alternatives

Other Treatment Options:

• Regular remote monitoring systems (for some VADs).
• Echocardiograms or other heart function tests.

Pros and Cons:

• Remote monitoring allows continuous oversight but may miss immediate physical inspection benefits.
• Echocardiograms provide detailed heart imaging but do not assess the VAD parameters directly.

Patient Experience

During the Procedure:

• Patients might feel slight discomfort during driveline inspection.
• Minimal physical sensation from the device interrogation process.

Post-procedure:

• Generally, no pain or discomfort.
• Immediate feedback and reassurance from the healthcare team.
• Pain management measures typically not necessary.