TN 5 (07-11)
DI 23022.570 Left Ventricular Assist Device Recipient
COMPASSIONATE ALLOWANCE INFORMATION
LEFT VENTRICULAR ASSIST DEVICE RECIPIENT
LVAD Recipient; Left Ventricle Assist Device Recipient; Heart Pump Recipient
The left ventricle is the large chamber of the heart that pumps blood out to the body. The left ventricular assist device (LVAD) is a mechanical pump surgically implanted to assist the heart in pumping blood to the body. The LVAD is the most common type of ventricular assist device. It is designed to pump blood from the left ventricle to the aorta. The aorta is the main artery that carries oxygen rich blood from the heart to the body. LVADs are implanted in people who have been diagnosed with end stage heart failure.
There are three primary reasons for implanting a LVAD:
LVADs are used during or after surgery, until a weakened heart recovers.
LVADs are used for people waiting for a heart transplant until a donor heart can be obtained.
LVADs are used as a long-term treatment for people with end stage heart failure who are not candidates for heart transplant (i.e. people with clotting disorders, irreversible kidney failure, severe liver disease, or infections that cannot be treated with antibiotics).
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Imaging studies, electrocardiogram (EKG), echocardiography, and blood tests to monitor for infections.
ONSET AND PROGRESSION
Prior to implantation of the LVAD, individuals are admitted into the hospital to prepare them for surgery. During this time, patients receive instruction on how the device works, safety precautions, how to respond to alarms, what to do in the event of a loss of electrical power, personal care before and after the implant, and how to prepare for changes in activities of daily living. Following implantation, there is a risk of infection, internal bleeding, heart failure, and mechanical breakdown of the LVAD. Response to implantation of an LVAD depends on the severity of the heart condition. Individuals with complications following surgery may require cardiac rehabilitation. Cardiac rehabilitation involves prescribed exercise training, education on heart healthy living, and counseling to reduce stress. LVAD recipients are medically monitored on a regular basis.
People who require mechanical circulatory support of an LVAD may require prolonged ventilation due to postoperative respiratory failure. Mobility is often limited due to multiple medical problems, life-support or monitoring equipment and weakness. These individuals may require physical therapy intervention, respiratory therapy, and cardiac rehabilitation on a case-by-case basis.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
Clinical description of findings, hospital admission and discharge summary, operative report, cardiology consultation, imaging studies, electrocardiogram (EKG), and echocardiography
Suggested Listings for Evaluation:
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.