CPT® Code 33776

1. Indications

The atrial baffle procedure, as described by CPT® Code 33776, is indicated for the surgical repair of transposition of the great arteries (TGA) in patients who may also present with associated cardiac anomalies. The specific indications for this procedure include:

• Transposition of the Great Arteries: A congenital heart defect where the aorta arises from the right ventricle and the pulmonary arteries arise from the left ventricle, leading to improper circulation of oxygenated and deoxygenated blood.
• Ventricular Septal Defect (VSD): An abnormal opening in the ventricular septum that allows for the mixing of oxygen-rich and oxygen-poor blood, necessitating closure during the repair of TGA.
• Subpulmonary Stenosis: A narrowing of the main pulmonary artery below the pulmonary valve, which may require individualized surgical intervention in conjunction with the atrial baffle procedure.

2. Procedure

The procedure for CPT® Code 33776 involves several critical steps to effectively repair transposition of the great arteries and close the ventricular septal defect. The steps are as follows:

• Step 1: The surgical team gains access to the heart through a median sternotomy or thoracotomy, allowing for adequate visualization and manipulation of cardiac structures.
• Step 2: The thymus gland is resected to facilitate access to the heart, and the pericardium is incised. A large section of the pericardium is harvested for later use as a patch graft.
• Step 3: Cannulation of the aorta and the superior and inferior vena cava is performed to establish cardiopulmonary bypass, which is essential for maintaining circulation while the heart is operated on.
• Step 4: The aorta is cross-clamped to control blood flow, and an incision is made in the right atrium to access the atrial septum.
• Step 5: The atrial septum is resected, and a patch made of synthetic material, autologous pericardium, or an allograft is used to create a baffle that redirects systemic venous blood from the superior and inferior vena cava to the orifice of the mitral valve, characteristic of the Mustard procedure.
• Step 6: The pulmonary venous blood is excluded from this pathway and is redirected to flow around the baffle to the tricuspid valve.
• Step 7: Alternatively, in the Senning procedure, flaps of the native atrial septum and atrial wall may be utilized to construct the intra-atrial baffles.
• Step 8: The previously harvested section of pericardium is used to patch the atrial wall, completing the baffle construction.
• Step 9: The ventricular septal defect is approached through the right atrium, with an incision made in the infundibulum to access the defect.
• Step 10: The VSD is repaired using a synthetic patch, pericardial patch, or xenograft patch to prevent the mixing of blood between the ventricles.
• Step 11: After the repairs are completed, the sternum may be closed or left open for subsequent closure in a later procedure, and chest tubes are placed as needed to facilitate drainage.

3. Post-Procedure

Following the atrial baffle procedure with closure of the ventricular septal defect, patients typically require close monitoring in a postoperative setting. Expected recovery may involve management of pain, monitoring for any signs of complications such as infection or bleeding, and ensuring proper cardiac function. The placement of chest tubes is common to assist in drainage and prevent fluid accumulation around the heart. The surgical team will assess the patient's recovery progress and may schedule follow-up appointments to evaluate the success of the procedure and the overall health of the patient. Depending on the individual case, further interventions may be necessary to address any residual issues related to the transposition of the great arteries or associated anomalies.