33989 Removal of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ECMO/ECLS

Name of the Procedure:

Removal of Left Heart Vent by Thoracic Incision (e.g., Sternotomy, Thoracotomy) for ECMO/ECLS

Summary

This surgical procedure involves removing a part of the left ventricle of the heart through an incision in the chest wall to facilitate Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support (ECLS). This is generally done in cases of severe heart failure.

Purpose

The procedure addresses severe heart failure or cardiogenic shock that is unresponsive to other therapies. The goal is to allow the heart to rest and recover while providing adequate blood circulation and oxygenation through ECMO/ECLS.

Indications

• Severe heart failure
• Cardiogenic shock
• Conditions where traditional medical therapy or less invasive procedures have failed
• Patients requiring ECMO/ECLS support due to compromised heart function

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting medications as advised by the physician
• Preoperative diagnostic tests such as blood work, echocardiogram, and chest X-rays
• Patient counseling about the procedure, risks, and recovery process

Procedure Description

1. Patient is given general anesthesia.
2. A thoracic incision is made, either through a sternotomy (cutting through the breastbone) or thoracotomy (cutting between the ribs).
3. Part of the left ventricle is surgically removed.
4. The heart is connected to ECMO/ECLS machines to take over the function of pumping blood and oxygenation.
5. Incisions are closed, and the patient is transferred to an intensive care unit for monitoring.

Tools and Equipment:

• Scalpel, rib spreader, surgical retractors
• ECMO/ECLS machine
• Anesthesia equipment

Duration

Approximately 4 to 6 hours.

Setting

Performed in a hospital operating room, often followed by intensive care unit (ICU) care.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionists (to operate the ECMO/ECLS machine)
• ICU staff for post-operative care

Risks and Complications

• Infection
• Bleeding
• Stroke
• Heart rhythm problems
• Potential for complications related to ECMO/ECLS

Benefits

• Improved heart function through rest and mechanical support
• Enhanced blood circulation and oxygenation
• Potential for heart recovery over time

Recovery

• ICU stay for critical monitoring and support
• Gradual weaning off ECMO/ECLS as heart function improves
• Pain management with medications
• Incision care and infection prevention
• Physical activity restrictions
• Follow-up appointments for ongoing evaluation and care

Alternatives

• Medical management with medications
• Less invasive procedures such as intra-aortic balloon pump
• Left ventricular assist device (LVAD) implantation
• Heart transplantation
• Each alternative varies in invasiveness, risk, and potential outcome.

Patient Experience

Patients will be under general anesthesia and therefore unconscious during the procedure. Post-operatively, they may experience discomfort from incisions and need pain management. The intensive care unit stay involves continuous monitoring, and the individual's activity will be limited initially to ensure proper healing and adjustment to the ECMO/ECLS support.