CPT® Code 32854

A double lung transplant, also known as bilateral lung transplant, is a surgical procedure that involves the replacement of both lungs in a patient with severe lung disease. This procedure can be performed using two primary techniques: bilateral sequential or en bloc. The bilateral sequential technique is the most commonly utilized method, where each lung is transplanted one at a time. The thorax, or chest cavity, is accessed through a bilateral anterolateral incision, typically made through the fourth or fifth intercostal space, allowing the surgeon to expose the lungs adequately. In cases where cardiopulmonary bypass is necessary, an additional incision may be made in the groin to facilitate access to the thoracic vessels for cannulation. During the procedure, the first lung is carefully excised from the recipient, and the donor lung is subsequently placed into the thoracic cavity. Various techniques may be employed for the transplant, including different orders of anastomosis for the bronchus, pulmonary artery, and pulmonary vein. The bronchial anastomosis involves a telescoping method where the smaller bronchus is inserted into the larger bronchus and sutured together, with the site covered by local tissue to promote healing. Following this, the donor and recipient pulmonary arteries are aligned and anastomosed to prevent kinking. The left atrium is clamped to prepare for the anastomosis of the pulmonary veins, where a cuff is created from the recipient's pulmonary vein, and the orifices are connected. Once the lung is reinflated, air is evacuated from the pulmonary vasculature, and perfusion is restored. The surgical team evaluates the suture lines, reinforcing them as necessary, and places chest tubes to facilitate drainage before closing the chest. A flexible bronchoscopy is performed to inspect the bronchial anastomosis and clear any blood or secretions. The second lung is then removed from the recipient and the second donor lung is transplanted using the same meticulous technique. If the procedure is performed without the need for cardiopulmonary bypass, a different CPT® code is used. In contrast, the en bloc technique, which involves transplanting both lungs as a single unit, requires cardiopulmonary bypass and is performed through a pleural and pericardial window.