Assembly and operation of pump with oxygenator or heat exchanger (with or without ECG and/or pressure monitoring); each hour
CPT4 code
Name of the Procedure:
Assembly and Operation of Pump with Oxygenator or Heat Exchanger (Cardiopulmonary Bypass)
Summary
Cardiopulmonary bypass involves the use of a specialized pump and oxygenator to take over the function of the heart and lungs during surgery. This ensures the body continues to receive oxygenated blood while the heart is stopped for major procedures.
Purpose
Cardiopulmonary bypass is primarily used during cardiac surgeries that require the heart to be still, such as valve repairs or coronary artery bypass grafting. The expected outcome is the successful completion of the surgery with uninterrupted oxygen delivery to the body's tissues.
Indications
- Severe coronary artery disease necessitating bypass surgery.
- Heart valve repair or replacement.
- Congenital heart defects requiring surgical intervention.
- Complex heart surgeries needing a still heart.
Preparation
- Fasting for at least 8 hours before surgery.
- Adjustment of medications, especially blood thinners.
- Preoperative diagnostics including blood tests, electrocardiogram (ECG), and chest X-ray.
Procedure Description
- The patient is placed under general anesthesia.
- Incisions are made to access the heart.
- Cannulas (tubes) are inserted into the heart and major blood vessels.
- The pump is assembled and connected to the cannulas.
- Blood is diverted to the oxygenator where it is oxygenated and then pumped back into the body.
- The surgeon performs the necessary cardiac procedure.
- After completion, the heart is restarted and the patient is gradually weaned off the pump.
- The cannulas are removed and the incisions are closed.
The procedure uses cardiopulmonary bypass machines, oxygenators, heat exchangers, and specialized tubes. General anesthesia ensures the patient is unconscious and pain-free during the surgery.
Duration
The assembly and operation of the pump with oxygenator are carried out for each hour during surgery, with the total surgery time varying based on the complexity of the heart procedure.
Setting
The procedure is performed in the operating room of a hospital, specifically in a cardiac surgery suite.
Personnel
- Cardiothoracic Surgeon
- Perfusionist (operates the bypass machine)
- Surgical Nurses
- Anesthesiologist
- Cardiologist (sometimes)
Risks and Complications
- Blood clots
- Bleeding
- Infection
- Neurological issues such as stroke
- Organ dysfunction (kidneys, lungs)
- Adverse reactions to anesthesia
Benefits
- Enables complex heart surgeries to be performed by temporarily replacing heart and lung functions.
- Provides a still and bloodless field for the surgeon, increasing the safety and effectiveness of the procedure.
- Immediate oxygenation and circulation of blood.
Recovery
- Close monitoring in the ICU post-surgery.
- Gradual removal of ventilators and other supportive equipment.
- Pain management with medications.
- Walking and breathing exercises to aid in recovery.
- Follow-up appointments for ongoing assessment.
Recovery time varies but often extends to several weeks, with specific instructions on wound care, activity restrictions, and medication.
Alternatives
- Off-pump coronary artery bypass: surgery performed without stopping the heart.
- Percutaneous coronary intervention (PCI): a less invasive procedure using cardiac catheterization.
- Medication management for less severe conditions.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel or experience anything. After waking up, they may experience discomfort or pain near the incision site, which is managed with pain medications. The initial days involve ICU care and gradual transition to less intensive monitoring. Fatigue and activity restrictions are common but gradually improve with time and rehabilitation.