32852 Lung transplant, single; with cardiopulmonary bypass

Name of the Procedure:

Lung Transplant, Single; with Cardiopulmonary Bypass
Common name(s): Single Lung Transplant with CPB

Summary

A single lung transplant involves replacing one diseased lung with a healthy lung from a donor. Cardiopulmonary bypass (CPB) is used during the procedure to take over the function of the heart and lungs, allowing the surgeon to perform the transplant.

Purpose

A lung transplant is intended to replace a damaged or diseased lung with a healthy lung to improve breathing and overall lung function. This procedure is often considered when other treatments have failed to improve the patient's condition.

Indications

• End-stage lung disease (e.g., COPD, pulmonary fibrosis)
• Severe pulmonary hypertension
• Cystic fibrosis
• Life-threatening lung damage from other causes Patients typically need to meet specific criteria such as being in relatively good health aside from their lung disease and not having other life-threatening conditions.

Preparation

• Patients may be required to fast for a specific period before the procedure.
• Diagnostic tests like chest X-rays, CT scans, and blood tests are conducted.
• Patients may need to adjust medications or temporarily stop certain drugs.
• Pre-procedure evaluations by the transplant team, including cardiologists, pulmonologists, and anesthesiologists.

Procedure Description

1. General anesthesia is administered.
2. An incision is made in the patient’s chest to access the lung.
3. The patient is connected to the cardiopulmonary bypass machine.
4. The diseased lung is removed.
5. The donor lung is placed and attached to the airways, blood vessels, and other connections.
6. The cardiopulmonary bypass is gradually discontinued as the new lung begins to function.
7. The incision is closed with sutures. Tools and equipment: Surgical instruments, CPB machine, donor lung storage and transport systems.

Duration

The procedure typically lasts between 6 to 12 hours, depending on complexity.

Setting

Performed in a hospital, specifically in an operating room equipped for transplant surgery.

Personnel

• Cardiothoracic surgeons
• Surgical nurses
• Anesthesiologists
• Perfusionists (operate the CPB machine)
• Post-operative care team

Risks and Complications

• Rejection of the donor lung
• Infection
• Bleeding
• Blood clots
• Respiratory complications or failure
• Surgery-related complications such as adverse reactions to anesthesia

Benefits

The lung transplant can significantly improve life expectancy and quality of life by enhancing breathing function. Benefits are often realized within a few weeks to months post-surgery, though improvement continues as the body adjusts.

Recovery

• Intensive care unit (ICU) stay immediately post-surgery.
• Continuous monitoring of lung function and vital signs.
• Immunosuppressive medications to prevent organ rejection.
• Pulmonary rehabilitation and physical therapy.
• Follow-up appointments for routine checks and monitoring.
• Recovery time varies from several weeks to months, with activity restrictions.

Alternatives

• Medical management with drugs like bronchodilators, corticosteroids
• Non-invasive ventilation or oxygen therapy
• Other surgical options like lung volume reduction surgery Pros and cons vary; alternatives may have less risk but also offer less improvement in lung function.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, the patient may experience discomfort or pain managed with medications. The experience involves a gradual return to physical activities, adjusting to the new lung function, and adhering to a strict regimen of medications and follow-up care.