CPT® Code 0806T

1. Indications

The transcatheter superior and inferior vena cava prosthetic valve implantation is indicated for the following conditions:

• Heart Failure This procedure is performed to treat patients experiencing heart failure, particularly when it is associated with severe tricuspid valve regurgitation.

2. Procedure

The procedure begins with the access of the left and right femoral veins percutaneously, which is a minimally invasive technique that allows for the introduction of necessary instruments without the need for large incisions. Once access is achieved, introducer sheaths are placed into the femoral veins to facilitate the subsequent steps. A pulmonary catheter is then inserted into the left femoral vein and carefully threaded up to the right pulmonary artery, reaching the area where it crosses the superior vena cava (SVC). This step is crucial for obtaining an angiogram of the SVC, which is performed using a catheter that is introduced through the right femoral vein. After the angiogram is completed, the catheter is exchanged for a guidewire, which serves as a pathway for the valve delivery system.

Next, a small incision is made at the access site to allow for the introduction of the valve delivery system. This system is threaded over the guidewire through the inferior vena cava (IVC) and into the right atrium and SVC. The positioning of the valve is critical; it is carefully placed with the upper portion at the juncture of the SVC and right atrium, and the middle portion positioned above the crossing of the right pulmonary artery. The correct placement is confirmed using fluoroscopy and echocardiogram imaging techniques, ensuring that the valve is optimally situated for effective function.

Once the positioning is verified, the upper portion of the valve is deployed first, followed by the complete unsheathing of the prosthetic valve. After deployment, the delivery system is removed over the guidewire, and the device is tested to ensure proper function. The catheter that was positioned at the crossing of the right pulmonary artery and SVC is then withdrawn and repositioned in the suprahepatic vein. This maneuver assists in positioning the IVC valve, which is subsequently loaded onto the delivery catheter and threaded up to the diaphragm, just above the hepatic vein inflow. The IVC valve is then carefully positioned at the cavo-atrial junction, utilizing intraprocedural mapping to avoid obstructing the hepatic vein. Once again, the valve is deployed, and its positioning is confirmed before all instruments are removed from the patient.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications that may arise from the intervention. This includes assessing the patient's hemodynamic status and ensuring that there are no signs of obstruction or valve malfunction. Patients may require follow-up imaging studies to evaluate the position and function of the newly implanted valves. Additionally, healthcare providers will monitor for any signs of infection at the access sites and manage pain as necessary. The recovery process will vary depending on the individual patient's condition and response to the procedure, but close observation is essential to ensure optimal outcomes.