CPT® Code 33779

1. Indications

The procedure is indicated for patients diagnosed with transposition of the great arteries, a congenital heart defect characterized by the abnormal connection of the aorta and pulmonary arteries. Specific indications for performing this surgical repair include:

• Transposition of the Great Arteries - A congenital anomaly where the aorta arises from the right ventricle and the pulmonary arteries arise from the left ventricle, leading to inadequate oxygenation of blood.
• Associated Cardiac Anomalies - Conditions such as ventricular septal defect (VSD) and subpulmonary stenosis that may complicate the transposition and require surgical intervention.
• Presence of a Pulmonary Band - The procedure is specifically indicated when there is a need to remove a previously placed pulmonary band that was used to manage pulmonary artery stenosis.

2. Procedure

The surgical procedure for CPT® Code 33779 involves several critical steps to repair the transposition of the great arteries:

• Accessing the Heart - The procedure begins with a median sternotomy or thoracotomy to gain access to the heart. This allows the surgeon to visualize and operate on the cardiac structures directly.
• Resecting the Thymus - The thymus gland is resected to provide better access to the heart and surrounding structures during the repair process.
• Incising the Pericardium - The pericardium, the fibrous sac surrounding the heart, is incised, and a section is harvested for later use as a patch graft in the reconstruction.
• Dissecting the Aorta and Pulmonary Artery - The ascending aorta and the main pulmonary artery, along with their branches, are carefully dissected free from surrounding tissues to prepare for the reconstruction.
• Cannulating the Aorta and Vena Cava - The aorta and the superior and inferior vena cava are cannulated to facilitate cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs during surgery.
• Establishing Cardiopulmonary Bypass - Cardiopulmonary bypass is initiated, and the aorta is cross-clamped to control blood flow during the procedure.
• Transecting the Aorta and Pulmonary Artery - The ascending aorta and the main pulmonary artery are transected to allow for the reconstruction of the arterial connections.
• Visualizing and Excising Coronary Artery Ostia - The ostia of the left and right coronary arteries at the anomalous aortic root are visualized and excised along with the adjacent aortic wall to facilitate their repositioning.
• Transferring Coronary Artery Ostia - The coronary artery ostia are transferred as buttons to the anomalous main pulmonary artery root sinuses in the left ventricle, ensuring proper blood supply to the heart muscle.
• Bringing Forward the Distal Main Pulmonary Artery - The distal main pulmonary artery and its branches are brought forward to connect with the right ventricle, while the aorta is repositioned posteriorly to the left ventricle.
• Anastomosing the Distal Aorta - The distal aorta is anastomosed to the newly created aortic root in the left ventricle, restoring normal blood flow dynamics.
• Anastomosing the Coronary Arteries - The coronary arteries are also anastomosed to the newly created aortic outflow tract, ensuring adequate perfusion of the heart muscle.
• Removing the Pulmonary Band - If a pulmonary band was previously placed, it is dissected free and removed during the procedure.
• Assessing Pulmonary Artery Stenosis - The pulmonary artery is assessed for stenosis using a transducer and probe, and dilation is performed as needed to ensure proper blood flow.
• Closing the Sternum - Following the completion of the repair, the sternum may be closed or left open, with the option to close it in a subsequent procedure. Chest tubes are placed as needed to manage any postoperative drainage.

3. Post-Procedure

After the completion of the surgical repair, patients typically require close monitoring in a postoperative setting. Expected recovery may involve managing pain, monitoring for any complications, and ensuring proper heart function. The sternum may be closed immediately or left open for later closure, depending on the surgeon's assessment. Chest tubes are placed to facilitate drainage and prevent fluid accumulation around the heart. Follow-up care will include regular assessments of heart function and any necessary interventions to address complications or additional cardiac anomalies.