HEART FAILURE PROCEDURES: WHAT TO EXPECT
If you will be undergoing a procedure to help treat or monitor heart failure, you may feel more comfortable with the procedure if you know what to expect. Your doctor and medical team will be the best source of information about heart failure procedures, so be sure to ask questions if you do not understand or want to know more.
RECEIVING A PULMONARY ARTERY (PA) PRESSURE SENSOR
If you are receiving a PA sensor, your doctor will permanently implant it in your pulmonary artery (the blood vessel that moves blood from your heart to your lungs). The sensor is about the size of a dime, with two thin loops at each end. It does not have any batteries or wires.
If your doctor determines you will need a general anesthetic for your procedure, an anesthesiologist will give you medications to put you to sleep. Most patients stay awake during the procedure, and receive a local anesthetic to numb the area where the device will be implanted. If you receive the local anesthetic, you may be able to hear and talk with the medical team during the procedure, and team members may have instructions for you. During the procedure, you may feel some pressure while the team implants your device, but you should not feel any pain. An electrocardiogram (EKG) will constantly monitor your heart rate and rhythm. The length of your procedure depends on the time it takes to position the sensor. Implanting a PA sensor typically involves these steps:
- A nurse will clean and inject a local anesthetic on an area of your upper thigh.
- Your doctor will make a small incision and insert a device called a catheter into your femoral vein (in your thigh).
- Using a fluoroscope (a type of X-ray), he or she will thread the catheter through your body to your heart and into your pulmonary artery.
- The doctor will check that the catheter is in the right position and release the sensor into your artery.
- The doctor will then hold an antenna to your back, chest or side to make sure that it can read the signals from your sensor.
IMMEDIATELY AFTER THE PROCEDURE
After your procedure has been completed, you may be asked to lie flat on your back for a few hours to prevent bleeding from the catheter insertion site. You may feel some mild discomfort at the injection site as you recover. Your doctor will tell you how long to expect to stay. You should be able to return to normal activities soon after the procedure. Your PA sensor works together with a bedside electronics unit that sends information to your doctor through a secure website. You will receive training on how to set up and take readings with your system before you go home
As with any medical procedure, there are risks associated with the implantation of a sensor, although complications are very rare. Some of these risks include arrhythmias, bleeding, death, device embolization, hematoma, infection, myocardial infarction, stroke, thrombus and transient ischemic attack. Be sure to talk with your doctor so that you thoroughly understand all of the risks and benefits associated with the implantation of a PA sensor. See Important Safety Information for the CardioMEMS™ HF System.
RECEIVING A CRT-P OR CRT-D DEVICE
The prospect of getting a cardiac resynchronization therapy (CRT) device can be exciting—it has the potential to help you live a longer, more productive and healthy life. Preparing for your procedure can also be scary because there are potential risks involved with implanting a cardiac device, as noted below
CRT PROCEDURE STEPS
If your doctor determines you will need a general anesthetic for your procedure, an anesthesiologist will give you medications to put you to sleep. Most patients stay awake during the procedure, and receive a local anesthetic to numb the area where the device will be implanted. If you receive the local anesthetic, you may be able to hear and even talk with the medical team during the procedure, and team members may have instructions for you, too. During the procedure, you may feel some pressure while the team implants your device, but you should not feel any pain. Implanting a CRT-P or CRT-D typically involves these steps:
- Your doctor makes a small cut in your upper chest and locates a vein.
- Your doctor makes a small puncture in the vein, and guides the leads down the vein to your heart.
- The surgical team monitors the lead placement in your heart using a large overhead monitor and a kind of X-ray machine called a fluoroscope.
- Once the leads are in place, your doctor tests them to make sure they are in the best position to deliver energy to your heart.
- Your doctor might ask you to go through some simple maneuvers, such as taking a deep breath or coughing vigorously, to make sure the leads are stable.
- Your doctor creates a “pocket” by making a small incision (cut) in the skin and separating the underlying tissue from the muscle beneath it.
- The surgical team connects the device to the leads and places it in the pocket.
- The team closes the incision.
The duration of the surgery depends on what kind of device you are getting, as well as your specific anatomy and the time it takes to locate a good position for the lead. In some cases, implanting a CRT-P or CRT-D can take a number of hours.
IMMEDIATELY AFTER THE PROCEDURE
After the procedure, you will go to a recovery room to be monitored. You may feel some discomfort, and you will be tired. Depending on your condition, you may stay in the hospital for several hours or up to several days. Your doctor will tell you how long to expect to stay
CRT IMPLANT PROCEDURE RISKS
Generally, risks depend on your age, general health, specific medical condition and heart function.
You should be aware of the following:
- A small number of patients develop complications from the operation to implant the CRT device and the leads in the body. These can include the following complications, which can usually be corrected or cured:
- A reaction to a drug used during surgery
- Blood loss
- Damage to a blood vessel, the heart wall or other organ.
- After the surgery, you may feel tired or have some discomfort, but these feelings last only a short time. Some patients, however, may continue to feel a bit uncomfortable in the area where the CRT was implanted.
- Modern CRT devices have many safety features. Sometimes a CRT device may not act properly because it is being affected by outside sources of electromagnetic energy.
- It is also possible for the tip of the lead to shift in the heart so that the pulse is no longer effective.
- Very rarely, the device may slip out of the “pocket” in the chest.
- Finally, remember these are man-made devices. It is important to monitor the device regularly with follow-up visits as often as your doctor recommends.
- Contact your doctor if:
- You notice you are tired, short of breath or your heart rate is changing
- You notice the wound is red, hot, swollen, more painful, or beginning to drain fluid
- Symptoms you had before the CRT device was implanted seem to return
In addition, you may have a small scar after the incision heals and a small bump where the implanted device rests in your chest. If you are very small or thin, the bump may be more pronounced. If you are concerned about this, your doctor may be able to place your device in a place that is less noticeable.
Your doctor is your best source of information about risks. Be sure to consult with him or her about risks before you undergo your procedure, and discuss any concerns you might have afterwards. Learn more about CRT-P and CRT-D safety and use.
RECEIVING AN LVAD
Preparing for your procedure to receive a left ventricular assist device (LVAD) may involve a number of steps. Because you will undergo open-heart surgery, you may be admitted to the hospital for a period of time before your surgery occurs, so your medical team can prepare you and your body for surgery. Your medical team is the best source of information about your treatment and care.
Because an LVAD is implanted in your body near your heart, your surgery may take several hours and typically involves these steps:
- An anesthesiologist will give you medications that put you to sleep.
- You may be connected to a ventilator to help you breathe during the procedure.
- Your surgeon will make a cut in your chest area to access your heart.
- You may be connected to a machine that helps pump your blood during the surgery.
- Depending on the product, your surgeon will place your LVAD near your heart or in an area just below your diaphragm in your abdomen. The device will be attached to your left ventricle and your aorta (the main artery that carries oxygenated blood from the left ventricle to the entire body).
- Once your LVAD is implanted and connected to an external controller, you will be disconnected from the blood-pumping machine and blood will begin to pump through your heart and your new LVAD.
IMMEDIATELY AFTER THE PROCEDURE
After surgery, you will stay in an intensive care unit (ICU). When you wake up, you will be connected to several tubes and machines to monitor your heart and body. You may need to remain connected to a ventilator until you are able to breathe on your own.
After your stay in the ICU, you will be moved to a different room where you will stay until you recover from surgery and your medical team is sure you are able to function with your LVAD on your own. Before you go home, your medical team will give you thorough instructions on LVAD care and explain how to care for the surgical site and address issues of personal hygiene, activity and other questions you may have.
LVAD IMPLANT PROCEDURE RISKS
Complications of LVAD surgery are similar to the potential complications of any open-heart surgery procedure. Side effects may include death, bleeding, cardiac arrhythmia, infection, respiratory failure, device malfunction, sepsis, right heart failure, renal failure, stroke, neurologic dysfunction, psychiatric episode, peripheral or device-related thromboembolic event, haemolysis, hepatic dysfunction, and myocardial infarction.
Consult your doctor about all possible benefits and risks of an LVAD. See Important Safety Information for the HeartMate II™ LVAD and Important Safety Information for the HeartMate 3™ LVAD.