33916 Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary bypass

Name of the Procedure:

Pulmonary Endarterectomy (PE) with or without Embolectomy, with Cardiopulmonary Bypass

Summary

A pulmonary endarterectomy is a surgical procedure used to remove chronic blood clots from the pulmonary arteries. It often requires the use of a cardiopulmonary bypass (a heart-lung machine) to maintain circulation and oxygenation during the operation. In some cases, an embolectomy (removal of an embolus) is also performed.

Purpose

This procedure addresses chronic thromboembolic pulmonary hypertension (CTEPH), a condition where blood clots obstruct the pulmonary arteries, leading to increased blood pressure in the lungs and heart strain. The goal is to improve blood flow, reduce pulmonary artery pressure, and alleviate symptoms like shortness of breath and fatigue.

Indications

• Persistent symptoms of pulmonary hypertension despite medical treatment
• Diagnosed CTEPH with significant obstruction in the pulmonary arteries
• Right heart failure or severe limitations in physical activity due to pulmonary hypertension

Preparation

• Fasting for about 8 hours before the procedure
• Adjustments in medications as advised by the physician, such as stopping blood thinners
• Preoperative tests including blood work, electrocardiogram (ECG), chest X-ray, and pulmonary angiography

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the chest to access the heart and lungs.
3. A cardiopulmonary bypass machine is connected to take over heart and lung functions.
4. The surgeon opens the pulmonary arteries and carefully removes the clots or emboli.
5. The arteries are then repaired, and the heart is gradually restarted as the patient is taken off the bypass machine.
6. The chest incision is closed, and the patient is moved to the ICU for monitoring.

Duration

The procedure typically takes about 6 to 10 hours.

Setting

The procedure is performed in a hospital operating room with subsequent intensive care unit (ICU) stay for recovery.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates the heart-lung machine)
• Respiratory therapist

Risks and Complications

• Common risks: bleeding, infection, arrhythmias
• Rare risks: stroke, organ failure, reocclusion of pulmonary arteries
• Management includes medications, additional surgeries, or supportive care in the ICU

Benefits

• Significant improvement in symptoms like shortness of breath and exercise capacity
• Reduced pulmonary artery pressure
• Potential to prevent heart failure and prolong life

Recovery

• The initial recovery involves ICU stay for close monitoring (1-2 weeks).
• Gradual mobilization and respiratory rehabilitation
• Full recovery may take several months, during which physical activity should be limited, and regular follow-up appointments are necessary.

Alternatives

• Medical management with anticoagulants and pulmonary hypertension-specific drugs
• Balloon pulmonary angioplasty (BPA) for patients who are not surgical candidates
• Lung transplantation in severe cases

Patient Experience

• Expected discomfort and soreness post-surgery, managed by pain medications
• Patients may feel weak and fatigued and will require assistance with daily activities initially
• Gradual improvement in breathing and physical stamina as recovery progresses