32854 Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass

Name of the Procedure:

Lung Transplant, Double (Bilateral Sequential or En Bloc); with Cardiopulmonary Bypass

Common Names:

• Double Lung Transplant
• Bilateral Lung Transplant

Medical Terms:

• Bilateral Sequential Lung Transplant
• En Bloc Lung Transplant

Summary

A double lung transplant with cardiopulmonary bypass is a major surgical procedure in which both of the patient's diseased lungs are replaced with healthy lungs from a deceased donor. Cardiopulmonary bypass provides mechanical support for the heart and lungs during the surgery.

Purpose

This procedure treats severe and life-threatening lung conditions. The main goal is to replace diseased lungs with healthy ones to improve breathing and quality of life.

Indications

• End-stage lung disease
• Chronic obstructive pulmonary disease (COPD)
• Pulmonary fibrosis
• Cystic fibrosis
• Pulmonary hypertension

Patient criteria often include:

• Severe, irreversible lung disease
• Poor prognosis without transplant
• Reasonable expectation of improved quality of life and function

Preparation

• Pre-procedure fasting (usually after midnight before surgery)
• Adjustment of medications as per doctor’s instructions
• Comprehensive diagnostic tests, including imaging (CT scans, X-rays), pulmonary function tests, and blood tests
• Psychosocial evaluation and counseling

Procedure Description

1. The patient is put under general anesthesia.
2. The surgical team makes an incision in the chest.
3. Cardiopulmonary bypass is initiated to take over the functions of the heart and lungs.
4. The diseased lungs are carefully removed.
5. Donor lungs are prepared and transplanted into the patient one at a time (sequential) or as a single block (en bloc).
6. Blood vessels and airways are meticulously connected.
7. Cardiopulmonary bypass is gradually weaned off as the new lungs start functioning.
8. Incisions are closed, and the patient is transferred to the Intensive Care Unit (ICU) for monitoring.

Tools, Equipment, and Technology

• Surgical instruments
• Cardiopulmonary bypass machine
• Anesthesia delivery systems

Anesthesia

• General anesthesia, rendering the patient unconscious and pain-free

Duration

• 6 to 12 hours, depending on complexity and patient's condition

Setting

• Performed in a hospital operating room equipped for complex surgery and intensive care support

Personnel

• Cardiothoracic surgeons
• Anesthesiologists
• Perfusionists (specialists who manage the cardiopulmonary bypass)
• Surgical nurses
• Respiratory therapists

Risks and Complications

• Infection
• Rejection of the donor lungs
• Excessive bleeding
• Blood clots
• Cardiovascular complications
• Kidney failure
• Airway complications
• Potential need for re-operation

Benefits

• Significant improvement in lung function and breathing
• Enhanced quality of life
• Increased life expectancy for patients with end-stage lung disease

Recovery

• ICU stay for close monitoring initially
• Gradual weaning off mechanical ventilation
• Extensive physiotherapy and pulmonary rehabilitation
• Lifelong immunosuppressive medications to prevent rejection
• Regular follow-up appointments for lung function tests and monitoring

Expected Recovery Time

• Initial hospital stay: 2 to 3 weeks
• Full recovery and rehabilitation: several months

Alternatives

• Medical management with medications and oxygen therapy
• Non-invasive ventilation
• Single lung transplant (for certain conditions)
• Palliative care

Pros and Cons of Alternatives

• Medication and oxygen therapy: less invasive but may not be sufficient for end-stage disease
• Single lung transplant: shorter operation time, benefits patients when only one lung is significantly affected

Patient Experience

• During the procedure: The patient is under general anesthesia and will not be conscious or feel pain.
• After the procedure: Pain managed with medications, initial discomfort from incisions and tubes, gradual return to normal activities with physical therapy.
• Long-term management involves regular checkups and adherence to medication regimens to prevent organ rejection and infection.

Pain management includes analgesics and other medications as needed to ensure the patient's comfort throughout the recovery process.