CPT® Code 33916

Pulmonary endarterectomy is a surgical procedure aimed at treating chronic thromboembolic pulmonary hypertension, a condition characterized by high blood pressure in the pulmonary arteries due to blood clots that obstruct blood flow. This procedure involves the removal of these obstructions to restore normal blood flow and improve heart function. The surgery typically requires access to the heart through a median sternotomy or thoracotomy, which involves making an incision in the chest to expose the heart and surrounding structures. During the procedure, the pericardium, the protective sac surrounding the heart, is incised to allow for better access to the proximal main pulmonary artery. To facilitate the surgery, the aorta and the superior and inferior vena cava are cannulated, and cardiopulmonary bypass is established, which temporarily takes over the function of the heart and lungs, allowing the surgeon to operate on a still heart. The main pulmonary artery is then incised, and if any emboli are present, they are removed. The procedure focuses on establishing the correct endarterectomy plane to effectively excise fibrous obstructive tissue from the main pulmonary artery and its branches, including the right and left pulmonary arteries, as well as lobar, segmental, and subsegmental branches. The endarterectomy is performed on one lung at a time, with reperfusion occurring after the first lung's procedure is completed, followed by a second period of cardiac arrest to perform the same procedure on the contralateral lung. Finally, the incisions in the pulmonary arteries are closed, chest tubes may be placed as necessary, and the chest incision is closed to complete the surgery.