33238 Removal of permanent transvenous electrode(s) by thoracotomy

Name of the Procedure:

Removal of Permanent Transvenous Electrode(s) by Thoracotomy
Common name(s): Lead Extraction via Thoracotomy
Technical term: Thoracotomy for Permanent Lead Removal

Summary

This procedure involves surgically removing permanent electrodes (leads) from the heart. The leads are extracted through an incision in the chest (thoracotomy) to ensure they are safely and completely removed.

Purpose

This procedure addresses complications and issues related to implanted cardiac leads, such as infection, lead malfunction, or lead displacement. The goal is to safely remove the problematic leads to prevent further health issues and allow for potential replacement or an alternative treatment.

Indications

• Chronic infection around the lead or pacemaker
• Lead malfunction that cannot be corrected from outside the body
• Mechanical complications such as lead fracture
• Lead displacement causing ineffective pacing or sensing
• Pacing system upgrades that require removal of old leads

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medications, particularly blood thinners, may need to be adjusted.
• Pre-procedure diagnostics may include blood tests, chest X-rays, and an electrocardiogram (ECG).
• Detailed medical history and physical examination.

Procedure Description

1. The patient is placed under general anesthesia to ensure they are asleep and pain-free.
2. An incision is made in the chest to expose the heart and lead attachment points.
3. The surgeon carefully detaches the lead(s) from the heart and any adhesions within the body.
4. Specialized tools and techniques may be used to safely extract the leads without causing damage to the heart or surrounding tissues.
5. The incision is closed, and a sterile dressing is applied.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity.

Setting

This procedure is performed in a hospital's operating room, equipped with specialized surgical and cardiac equipment.

Personnel

• Cardiothoracic surgeon
• Cardiac anesthesiologist
• Surgical nurses
• Surgical technologist
• Perfusionist (in some cases)

Risks and Complications

Common risks:

• Infection
• Bleeding
• Pain at the incision site

Rare but serious complications:

• Damage to the heart muscle or blood vessels
• Stroke or other embolic events
• Prolonged air leaks or pneumothorax
• Cardiac arrest

Benefits

• Resolution of infections or complications related to the leads
• Improvement in heart function and patient symptoms
• Prevention of further health issues related to malfunctioning leads

Recovery

• Patients typically spend several days in the hospital for monitoring post-surgery.
• Pain management includes prescribed pain medications and activity restrictions.
• Follow-up appointments are necessary to monitor healing and heart function.
• Full recovery may take several weeks, with gradual resumption of normal activities.

Alternatives

• Percutaneous lead extraction (less invasive but may not be suitable for all patients)
• Conservative management (treating symptoms without lead removal, viable in less severe cases)
• Medications or antibiotics for infection control if surgery is high risk

Pros and Cons:

• Percutaneous extraction is less invasive but may not be as comprehensive for severe cases.
• Conservative management avoids surgery but may not address the underlying issue.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel any pain. Post-procedure, there will be some discomfort and soreness at the incision site. Pain is typically managed with medications. Hospital staff will support the patient with early mobilization and breathing exercises to aid recovery.