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The procedure described by CPT® Code 33440 involves the replacement of the aortic valve through a specialized surgical technique known as the Ross-Konno procedure. This complex operation is primarily indicated for patients suffering from multilevel left ventricular outflow tract obstruction (LVOTO), which can arise from various congenital heart defects such as severe annular hypoplasia, dysplastic aortic valves, and diffuse subaortic narrowing. LVOTO is frequently associated with Shone’s syndrome, particularly following the primary repair of an interrupted aortic arch (IAA) or in cases of congenital valve stenosis. The surgical approach requires opening the chest and establishing cardiopulmonary bypass to facilitate a safe and controlled environment for the procedure. The aorta is cross-clamped and partially transected to allow for a thorough examination of the aortic valve, while the pulmonary artery is also transected to assess the pulmonary valve. The procedure includes the harvesting of the pulmonary autograft, which is then utilized to replace the aortic valve, along with necessary modifications to the left ventricular outflow tract to ensure proper blood flow and function. This intricate surgical intervention aims to alleviate the obstruction and restore normal hemodynamics in the heart, ultimately improving the patient's quality of life and long-term outcomes.
© Copyright 2025 Coding Ahead. All rights reserved.
The Ross-Konno procedure, represented by CPT® Code 33440, is indicated for the treatment of complex multilevel left ventricular outflow tract obstruction (LVOTO). This condition may present in various forms, including:
The Ross-Konno procedure involves several critical steps to effectively replace the aortic valve and address LVOTO. The procedure begins with the opening of the chest and the establishment of cardiopulmonary bypass to maintain circulation during surgery. The aorta is then cross-clamped and partially transected to allow for a detailed examination of the aortic valve. Following this, the pulmonary artery (PA) is transected proximal to its bifurcation, enabling the surgeon to inspect the pulmonary valve. The transection of the aorta continues to facilitate the formation of right and left coronary artery buttons, allowing for maximal mobilization of the aortic cusps and sinus wall, which are subsequently removed while leaving a small cuff of the aortic wall intact.
Next, the pulmonary autograft is harvested, ensuring that an extension of the infundibular free wall muscle remains attached. This muscle will be used later for ventriculoplasty incision patching. Cardioplegia is administered to assess the harvest site for any bleeding, which is managed using diathermy or shallow sutures. The intraventricular septum is then exposed to the left of the right coronary artery, with the incision extended beyond the obstruction. If necessary, endocardial fibroelastosis or ventricular myectomy resection is performed to remove any fibrous tissue obstructing the left ventricular outflow tract (LVOT) and limiting the movement of the left ventricular cavity.
Using a running suture technique, the pulmonary autograft is implanted into the LVOT, with the left semilunar cusp of the autograft positioned at the site of the previous left coronary cuff. The infundibular free wall muscle harvested with the pulmonary valve is utilized to patch the triangular area of the incised interventricular septum. A running adventitial suture is placed over the remnant of the aortic wall to reinforce the primary suture line and minimize the risk of bleeding from the posterior anastomosis. The ventriculoplasty incision, patched with the infundibular free wall muscle, is further reinforced with interrupted mattress sutures to reduce the risk of bleeding and aneurysm formation.
Following these steps, the left coronary artery button is implanted into the pulmonary artery wall opening using a continuous suture. The ascending aorta is then anastomosed proximally to reconstruct the neoaorta, and the neoaortic root is expanded using cardioplegia to determine the appropriate position for the right coronary artery implantation. A circular opening is created in the wall of the pulmonary artery at the selected location, and the right coronary artery is implanted. Finally, the right ventricular outflow tract (RVOT) is reconstructed using a homograft, which is sutured directly to the right ventricular infundibular muscle. The patient is then weaned from cardiopulmonary bypass, and the chest incision is closed.
Post-procedure care following the Ross-Konno procedure involves close monitoring of the patient in a critical care setting to ensure stable hemodynamics and recovery from anesthesia. Patients may require support for respiratory function and hemodynamic stability as they transition off cardiopulmonary bypass. The surgical site will be monitored for signs of infection or complications, such as bleeding or fluid accumulation. Patients are typically observed for several days in the hospital, with gradual mobilization encouraged as tolerated. Follow-up echocardiograms may be performed to assess the function of the new aortic valve and the overall condition of the heart. Long-term follow-up is essential to monitor for any potential complications or need for further interventions.
| Short Descr | RPLCMT A-VALVE TLCJ AUTOL PV | Medium Descr | RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE | Long Descr | Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (Ross-Konno procedure) | 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) | none | MUE | 1 |
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) |
| 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2019-01-01 | Added | Added |
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