33243 Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy

Name of the Procedure:

Removal of Single or Dual Chamber Implantable Defibrillator Electrode(s) by Thoracotomy

Summary

In this procedure, one or two electrodes (leads) of an implantable defibrillator are surgically removed through an incision in the chest (thoracotomy). These electrodes help regulate heartbeats and alleviate life-threatening arrhythmias.

Purpose

The procedure addresses issues with the implantable defibrillator's electrodes, such as lead malfunction, infection, or lead displacement. The goal is to safely remove and replace problematic leads to ensure the defibrillator functions correctly.

Indications

• Defibrillator lead malfunction
• Lead infection or inflammation
• Lead displacement or fracture
• Chronic pain at the implantation site
• Necessity for defibrillator upgrade or exchange

Preparation

• Fasting for at least 8 hours prior to the procedure
• Adjustment or temporary discontinuation of certain medications (as instructed by the healthcare provider)
• Pre-procedure diagnostic tests, including electrocardiogram (ECG), chest X-ray, and blood tests

Procedure Description

1. The patient receives general anesthesia.
2. An incision is made in the chest to access the heart and the defibrillator leads.
3. Surgical tools are used to carefully detach and remove the affected leads.
4. The surgical site is meticulously inspected to ensure no parts of the lead remain.
5. In some cases, new leads are implanted and connected to the defibrillator.
6. The incision is closed with sutures or staples.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Pneumothorax (collapsed lung)
• Heart or blood vessel injury
• Anesthesia-related complications
• In rare cases, death

Benefits

• Resolution of malfunctioning or infected defibrillator leads
• Improved defibrillator functionality
• Reduced risk of future complications
• Enhanced quality of life and symptom relief

Recovery

• Hospital stay of 2-5 days for monitoring and recovery
• Pain management with prescribed medication
• Follow-up appointments with the cardiologist
• Avoidance of strenuous activities for a specified period
• Monitoring for signs of infection or complications

Alternatives

• Lead extraction using less invasive methods such as laser or mechanical extraction
• Medication management for arrhythmias
• External defibrillator use
• Each alternative has its own risks and benefits, which should be discussed with a healthcare provider.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel pain.
• Post-procedure, there may be discomfort and chest pain, managed with pain relievers.
• Follow-up care includes check-ups and possibly wound care instructions to ensure proper healing and functionality of the defibrillator.