Replacement, tricuspid valve, with cardiopulmonary bypass
CPT4 code
Name of the Procedure:
Replacement of the Tricuspid Valve with Cardiopulmonary Bypass
Common name(s): Tricuspid Valve Replacement (TVR)
Summary
Tricuspid valve replacement is a heart surgery where a damaged or faulty tricuspid valve is replaced with a mechanical or biological valve. The surgery is performed with the aid of cardiopulmonary bypass, a machine that takes over the heart and lung functions during the procedure to maintain circulation and oxygenation.
Purpose
This procedure addresses tricuspid valve disease, which can include tricuspid regurgitation or tricuspid stenosis. The goal is to restore normal valve function, improve blood flow, reduce symptoms such as fatigue and swelling, and prevent complications like heart failure.
Indications
- Severe tricuspid regurgitation or stenosis not manageable with medication
- Symptoms including fatigue, swelling, shortness of breath, and ascites
- Structural anomalies of the tricuspid valve
- Failure of previous tricuspid valve repair or prosthesis
Preparation
- Fasting for 8-12 hours before the procedure
- Medication adjustments as directed by the physician
- Diagnostic tests like echocardiogram, electrocardiogram (ECG), chest X-ray, and blood tests
- Pre-surgical assessment including physical examination and consultation with the surgical team
Procedure Description
- General anesthesia is administered to ensure the patient is unconscious and pain-free.
- A median sternotomy (incision down the middle of the chest) is performed to access the heart.
- The patient is connected to a cardiopulmonary bypass machine.
- The heart is temporarily stopped, and the damaged tricuspid valve is removed.
- A new mechanical or biological valve is sewn into place.
- The heart is restarted, and the patient is gradually taken off the bypass machine.
- The chest incision is closed, and the patient is moved to the intensive care unit (ICU) for monitoring.
Tools and equipment: Cardiopulmonary bypass machine, surgical instruments, mechanical/biological valve prosthesis
Duration
The procedure typically takes 3-5 hours.
Setting
The surgery is performed in a hospital's operating room under sterile conditions.
Personnel
- Cardiothoracic Surgeon
- Surgical Nurses
- Anesthesiologist
- Perfusionist (operates the cardiopulmonary bypass machine)
- Critical Care Team for post-operative care
Risks and Complications
- Bleeding
- Infection
- Blood clots
- Valve dysfunction or failure
- Stroke
- Heart attack
- Arrhythmias
- Reaction to anesthesia
- Long-term risks include valve degeneration or thrombosis (in case of mechanical valves)
Benefits
- Improved quality of life
- Relief from symptoms such as fatigue and swelling
- Enhanced heart function
- Decreased risk of heart failure and other complications
Recovery
- ICU stay for 1-2 days with continuous monitoring
- Hospital stay for about a week
- Gradual return to normal activities in 6-8 weeks
- Restrictions include avoiding heavy lifting and straining
- Follow-up appointments for monitoring valve function and overall recovery
Alternatives
- Medical management with medications to control symptoms
- Tricuspid valve repair (if feasible)
- Percutaneous (catheter-based) valve procedures
- Each alternative has its pros and cons; repair may preserve more natural heart function, while medications may not be sufficient for severe cases.
Patient Experience
Patients will be under general anesthesia during the procedure and will not feel or remember it. Post-procedure, there may be discomfort or pain at the incision site, managed with pain medications. Patients may experience fatigue, and swelling initially, followed by gradual improvement as recovery progresses. Pain management and other comfort measures will be provided throughout the hospital stay.