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The procedure described by CPT® Code 33404 involves the construction of an apical-aortic conduit, a surgical intervention primarily aimed at treating aortic stenosis. Aortic stenosis is a condition characterized by the narrowing of the aortic valve, which impedes blood flow from the heart to the aorta and subsequently to the rest of the body. The construction of this conduit allows for an alternative pathway for blood to bypass the obstructed aortic valve, thereby improving hemodynamics and alleviating symptoms associated with the stenosis. During the procedure, a left lateral incision is made through the sixth intercostal space to access the heart. The inferior pulmonary ligament is divided, and the lung is retracted to provide a clear view of the cardiac apex and the aorta. A synthetic tube graft is then anastomosed to the aorta in an end-to-side manner and connected to a porcine valve, facilitating the flow of blood from the left ventricle through the conduit into the aorta. This complex surgical technique requires careful manipulation of cardiac structures and precise suturing to ensure proper function and integration of the conduit with the heart's anatomy.
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The construction of an apical-aortic conduit is indicated for patients suffering from aortic stenosis, a condition that leads to the narrowing of the aortic valve, resulting in restricted blood flow from the heart. This procedure is typically performed when the stenosis is severe enough to warrant surgical intervention to alleviate symptoms such as shortness of breath, chest pain, or syncope, and to improve overall cardiac output and function.
The procedure begins with the surgeon making a left lateral incision through the sixth intercostal space to gain access to the heart. This incision allows for adequate exposure of the cardiac apex and the aorta. Following the incision, the inferior pulmonary ligament is divided, and the lung is retracted to provide a clear view of the surgical field. A synthetic tube graft is then anastomosed to the aorta in an end-to-side fashion, which involves connecting the graft to the aorta at one end while the other end is connected to a porcine valve. This setup is crucial for redirecting blood flow from the left ventricle.
Next, the pericardium is incised to expose the apex of the heart. A needle is carefully passed through the heart apex into the left ventricle, allowing for the creation of an opening. A guidewire is then introduced, followed by dilators, to facilitate the enlargement of this opening. Once the opening is established, it is temporarily occluded using an occlusion balloon that is passed over the guidewire to prevent blood loss during the subsequent steps.
With the occlusion balloon in place, a ventricular coring device is threaded over the catheter to remove a core of ventricular muscle from the apex. This step is critical for creating a suitable site for the connector. After the core is removed, a connector is inserted into the surgically created opening in the ventricle. The surgeon then places sutures through the ventricular muscle, around the opening in the apex, and into the external cuff of the connector to secure it in place. Finally, the ventricle connector is sutured to the valved conduit, ensuring a stable and functional connection for blood flow.
Upon completion of the procedure, chest tubes are placed as needed to facilitate drainage, and the chest incision is meticulously closed to promote healing.
After the completion of the apical-aortic conduit construction, patients typically require monitoring in a postoperative setting to assess for any complications. The placement of chest tubes is essential for draining any excess fluid or air that may accumulate in the thoracic cavity. Recovery may involve pain management and gradual mobilization as tolerated. The surgical team will monitor the patient's vital signs and cardiac function closely to ensure that the conduit is functioning properly and that there are no signs of infection or other postoperative complications. Follow-up care will be necessary to evaluate the long-term success of the procedure and the patient's overall cardiac health.
| Short Descr | PREPARE HEART-AORTA CONDUIT | Medium Descr | CONSTRUCTION APICAL-AORTIC CONDUIT | Long Descr | Construction of apical-aortic conduit | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 43 - Heart valve procedures |
This is a primary code that can be used with these additional add-on codes.
| 33141 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting PUB 100 CPT Assistant Article Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (List separately in addition to code for primary procedure) | 33257 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure) | 33259 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (List separately in addition to code for primary procedure) | 33530 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure) | 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). |
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