33305 Repair of cardiac wound; with cardiopulmonary bypass

Name of the Procedure:

Repair of cardiac wound; with cardiopulmonary bypass

Summary

This procedure involves surgically repairing a wound in the heart while the heart is temporarily stopped. During the operation, a cardiopulmonary bypass machine takes over the function of the heart and lungs, allowing the surgeon to fix the cardiac wound accurately and safely.

Purpose

This procedure addresses serious injuries or wounds to the heart, which could be caused by trauma or certain medical conditions. The goal is to repair the heart and restore its function, preventing life-threatening complications and promoting recovery.

Indications

• Cardiac wounds or injuries resulting from trauma (e.g., stab wounds, gunshot injuries)
• Perforations or tears in the heart caused by invasive medical procedures
• Severe cardiac conditions that lead to structural damage needing direct repair

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Instructions to stop certain medications will be provided.
• Pre-procedure diagnostic tests could include blood tests, electrocardiograms (ECG), echocardiograms, and CT scans.
• A thorough medical history and physical examination will be conducted.

Procedure Description

1. Anesthesia is administered to ensure the patient is unconscious and pain-free.
2. The chest is opened via a sternotomy (surgical incision through the breastbone).
3. The cardiopulmonary bypass machine is connected, taking over the heart and lung functions.
4. The heart is stopped using a chemical solution.
5. The surgeon identifies and repairs the cardiac wound using sutures or surgical adhesives.
6. Once the repair is complete, the heart is restarted, and normal circulation is resumed.
7. The chest incision is closed in layers, and the patient is moved to a recovery area.

The surgery utilizes specialized equipment such as a cardiopulmonary bypass machine, surgical instruments for cardiac repair, and anesthesia devices.

Duration

The procedure typically takes between 3 to 5 hours, depending on the complexity of the wound and the patient's condition.

Setting

This procedure is performed in a hospital operating room, equipped with advanced surgical and monitoring equipment.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (who operates the cardiopulmonary bypass machine)
• Surgical technologists

Risks and Complications

• Infection
• Blood clots
• Stroke
• Heart attack
• Bleeding
• Adverse reactions to anesthesia
• Arrhythmias (irregular heartbeats)
• Respiratory complications

Complications, though rare, are managed through immediate medical intervention and supportive care.

Benefits

• Effective repair of life-threatening cardiac injuries
• Restoration of normal heart function
• Prevention of further damage and complications

Patients can often see improvements soon after the procedure, typically within days to weeks.

Recovery

• Immediate post-operative care in the ICU for monitoring.
• Gradual transition to less intensive care as the patient stabilizes.
• Pain management, wound care, and gradual mobilization.
• Restrictions on physical activity for several weeks.
• Follow-up appointments to monitor heart function and recovery progress.

Alternatives

• Less invasive surgical procedures, if applicable
• Medical management and observation for less severe conditions
• In some cases, minimally invasive techniques like cardiac catheterization

The alternatives depend on the specific condition and severity of the cardiac injury, often balancing the risks and benefits of each option.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel any discomfort. Post-procedure, patients may experience pain and discomfort at the incision site, managed with medications. Recovery involves close monitoring and support to ensure the heart is functioning properly, with gradual improvement in symptoms and physical abilities.