33988 Insertion of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ECMO/ECLS

Name of the Procedure:

Insertion of Left Heart Vent via Thoracic Incision (e.g., sternotomy, thoracotomy) for ECMO/ECLS

Summary

This procedure involves surgically placing a vent into the left heart ventricle through a thoracic incision to support heart and lung function using Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support (ECLS).

Purpose

The procedure is performed to support patients with severe heart or lung failure. The goal is to oxygenate the blood and remove carbon dioxide while resting the patient's heart and lungs.

Indications

• Severe cardiac failure
• Acute respiratory distress syndrome (ARDS)
• Post-cardiac surgery complications
• Life-threatening respiratory or cardiac conditions needing ECMO/ECLS

Preparation

• Complete fasting for at least 8 hours prior
• Adjustment or temporary cessation of certain medications (e.g., anticoagulants)
• Pre-operative diagnostic tests such as blood work, ECG, and imaging studies (chest X-ray, echocardiogram)

Procedure Description

1. The patient is administered general anesthesia.
2. A thoracic incision (sternotomy or thoracotomy) is made for access to the heart.
3. The heart vent is positioned into the left ventricle.
4. Cannulae are inserted, and the ECMO/ECLS circuit is connected.
5. Blood is pumped out of the body, oxygenated via the ECMO/ECLS machine, and returned to the body, bypassing the heart and lungs.

Duration

Typically, the procedure takes between 2 to 4 hours.

Setting

The procedure is performed in a hospital operating room or specialized cardiac center.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Perfusionist
• Surgical nurses and support staff

Risks and Complications

• Infection
• Bleeding
• Blood clot formation
• Stroke or other embolic events
• Device malfunction or failure
• Possible damage to surrounding structures

Benefits

• Improved oxygenation and carbon dioxide removal
• Stabilization of cardiac and respiratory function
• Potential recovery of heart and lung function
• Bridge to recovery, heart transplant, or long-term mechanical support

Recovery

• Intensive care unit (ICU) monitoring post-procedure
• Ventilator support may be required initially
• Regular blood tests, imaging studies, and clinical assessments
• Gradual physical rehabilitation and monitoring of heart/lung function
• Follow-up appointments for device management and recovery assessment

Alternatives

• Mechanical ventilator support alone
• Medical management with inotropic agents
• Left Ventricular Assist Device (LVAD)
• Heart transplantation
• Pros and cons include the specificity of treatment response, invasiveness, and availability of resources.

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware. Post-procedure may involve discomfort from the incision and breathlessness requiring ventilator support. Pain is managed with analgesics, and comfort measures include regular monitoring, supportive care, and gradual physical rehabilitation.