CPT® Code 0580T

1. Indications

The removal of a substernal implantable defibrillator pulse generator is indicated in specific clinical scenarios. These may include:

• Device Malfunction The pulse generator may need to be removed if it is not functioning correctly, which could pose risks to the patient.
• Complications Patients may experience complications related to the device, such as infection or discomfort, necessitating its removal.
• Device Replacement If a newer model or a different type of defibrillator is required, the existing pulse generator must be removed before the implantation of a new device.
• Patient Decision In some cases, patients may choose to have the device removed due to personal preferences or changes in their medical condition.

2. Procedure

The procedure for the removal of a substernal implantable defibrillator pulse generator involves several key steps:

• Step 1: Preparation The patient is positioned appropriately, and the surgical site is cleaned and sterilized to minimize the risk of infection. Anesthesia is administered to ensure the patient is comfortable throughout the procedure.
• Step 2: Incision A surgical incision is made over the location of the pulse generator, which is typically found in the left axillary region. This incision allows access to the subcutaneous pocket where the device is housed.
• Step 3: Detachment of Electrodes Any electrodes connected to the pulse generator are carefully detached. This step is crucial to ensure that the device can be removed without causing damage to surrounding tissues.
• Step 4: Removal of the Pulse Generator The pulse generator is then gently extracted from its subcutaneous pocket. Care is taken to avoid any trauma to the surrounding tissues during this process.
• Step 5: Closure Once the pulse generator has been successfully removed, the incision is closed using sutures or staples, and appropriate dressings are applied to protect the surgical site.

3. Post-Procedure

After the removal of the substernal implantable defibrillator pulse generator, patients are typically monitored for any immediate complications, such as bleeding or infection. Post-procedure care may include pain management and instructions for wound care to ensure proper healing. Patients are advised to avoid strenuous activities for a specified period to allow for recovery. Follow-up appointments may be scheduled to assess the surgical site and discuss any further treatment options if necessary.