BVS 5000
The implantation, removal, and replacement (33981, 33982, 33983) of the biventricular assist device known as the BVS 5000 is covered when used as a single ventricular (33975, 33977, 33979, 33980) or biventricular device (33976, 33978) in accordance with its FDA-approved uses for:

1. postcardiotomy ventricular dysfunction (429.4);
   
   
2. treatment of right heart failure following insertion of an implantable left ventricular device (428.0, 428.20-428.23, 428.30-428.33, 428.40-428.43, 996.72);
   
   
3. treatment of cardiogenic shock following cardiac transplantation (785.51, 996.83).

The BVS 5000 device is intended for short term use and is not covered when used as a bridge to cardiac transplantation.

THORATEC
The implantation, removal, and replacement (33981, 33982, 33983) of the device known as the Thoratec Ventricular Assist Device System is covered when used as a single ventricular (33975, 33977, 33979, 33980) or biventricular device (33976, 33978) in accordance with its FDA-approved use as a bridge to cardiac transplantation for patients suffering from end-stage heart failure (428.0, 428.1, 428.20-428.23, 428.30-428.33, 428.40-428.43, 428.9). The Thoratec Ventricular Assist Device System is indicated for patients who meet all of the following criteria:

1. candidate for cardiac transplantation,
   
   
2. imminent risk of dying before donor heart procurement, and
   
   
3. dependence on, or incomplete response to, continued vasopressor support.

The Thoratec Ventricular Assist Device System is indicated for postcardiotomy patients who are unable to be weaned from cardiopulmonary bypass.

The implantation (33975, 33979), removal (33977, 33980), and replacement (33981, 33982, 33983) of the following devices is covered as destination therapy in accordance with the FDA-approved usage. Destination therapy is defined as permanently implanting the device for patients who are not considered candidates for a heart transplant:

• Thoratec HeartMate Vented Electric Left Ventricular Assist System (VAS)
• Thoratec HeartMate XVE LVAS
• Thoratec HeartMate Left Ventricular Assist System (SNAP VE LVAS)

Both of the following criteria must be met:

1. The patient has end-stage heart failure (428.0, 428.1, 428.20-428.23, 428.30-428.33, 428.40-428.43, 428.9); and,
   
   
2. The patient is not eligible for cardiac transplantation.

In addition to the criteria listed above, the following enrollment criteria (required for the REMATCH trial) must be met:

• At least 18 years of age
• Chronic heart failure (NYHA Class IV or III on inotropes/IABAP)
• Patients ineligible for cardiac transplant due to age, diabetes, kidney failure, or other co-morbidity
• Receiving reasonable doses of: digoxin, diuretics, and ACE Inhibitors (unless intolerant)
• Left Ventricular Ejection Fraction ≤ 25%
• VO2 max ≤ 14 ml/kg/min (unless failed inotrope wean)

The exclusion criteria includes:

• Any medical condition that, if corrected, would improve heart function
• Any condition that could result in a poor surgical risk
• Prior cardiac transplant, left ventricular reduction, or cardiomyoplasty
• Stroke, impaired cognitive function, history of severe cerebral vascular disease
• Severe end organ damage

OTHER DEVICES
The implantation (33975, 33979), removal (33977, 33980), and replacement (33981, 33982, 33983) of the following single ventricular assist devices is covered when used in accordance with FDA-approved labeled use for patients with irreversible left ventricular congestive failure (398.91, 428.1, 428.20-428.23, 428.30-428.33, 428.40-428.43) awaiting a donor heart for transplantation. The patient's condition should be deteriorating so rapidly that they are likely to die within 24 to 48 hours. Also, the patients must be on their hospital's transplant list. The devices are:

• The HeartMate Implantable Pneumatic left Ventricular Assist System
• The HeartMate Vented Electric Left Ventricular Assist System
• Novacor Left Ventricular Assist System

In addition, the TandemHeart (CardiacAssist)(codes *33999, 0048T, 0050T) is a covered device specifically designed for short-term stabilization of patients in the postoperative setting. This device is unique in that it allows for percutaneous access through the femoral vein, permitting rapid deployment. In addition, it is the first ventricular assist device that uses continuous axial flow, as opposed to pulsatile flow.

Total artificial hearts (0051T, 0052T, 0053T), in which the recipient undergoes a cardiectomy, represent a natural extension of ventricular assist devices as destination therapy. The CardioWest Total Artificial Heart is a covered device specifically as a bridge to transplantation. This device is unique in that a pulsatile biventricular device is placed after the native ventricles are excised. The labeled indication states that this device should only be used in an inpatient setting.

Total artificial hearts with FDA-approved devices may be considered medically necessary as a bridge to heart transplantation for patients with biventricular failure who are currently listed as heart transplant candidates.

Other artificial hearts (0051T, 0052T, 0053T) and other ventricular assist devices are still considered experimental/investigational as they do not have FDA approval. Therefore, claims reporting services in connection with the implantation of these devices should be denied.

*For prolonged extracorporeal percutaneous transseptal ventricular assist device, use not otherwise classified code 33999.

Description

Artificial hearts and ventricular assist devices are devices which either replace all or part of a human heart, or assist the heart in performing its pumping function. Artificial hearts may be used as a permanent replacement for a human heart, or as a temporary life-support system until a human heart becomes available for transplant. Ventricular assist devices are used as a temporary method of supporting heart functions.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

Results of a Multicenter Clinical Trial with the Thoratec Implantable Ventricular Assist Device, The Journal of Thoracic and Cardiovascular Surgery, Vol. 133, No. 6: 1573-1580

Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure, The New England Journal of Medicine, Vol. 355, No. 18, November 2, 2006

Left Ventricular Assist Devices as Destination Therapy: A New Look at Survival, The Journal of Thoracic and Cardiovascular Surgery, Vol. 129, No. 1: 9-17

Cardiac Replacement with a Total Artificial Heart as a Bridge to Transplantation, The New England Journal of Medicine, Vol. 351, No. 9, August 26, 2004

The Thoratec Implantable Ventricular Assist Device (IVAD): Initial Clinical Experience, The Heart Surgery Forum, Vol. 9, No. 4: E690-E692, June 2006

Birks EJ, et al. Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure. The New England Journal of Medicine. 2007 Mar;355(18):1873-1884.

Long JW, Healy AH, Rasmusson BY, et al. Improving outcomes with long-term “destination” therapy using left ventricular assist devices. J Thorac Cardiovasc Surg. 2008 June;135(6):1353-60.

John R, Kamdar F, Liao K, et al. Improved survival and decreasing incidence of adverse events with the HeartMate II left ventricular assist device as bridge-to-transplant therapy. Ann Thorac Surg. 2008 Oct;86(4):1227-34.