CPT® Code 33780

1. Indications

The procedure is indicated for the surgical correction of transposition of the great arteries, particularly in patients presenting with the following conditions:

• 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 inadequate oxygenation of blood.
• Ventricular Septal Defect (VSD) An abnormal opening in the ventricular septum that allows oxygen-rich and oxygen-poor blood to mix, often requiring closure during the surgical repair.
• Subpulmonary Stenosis A narrowing of the main pulmonary artery below the pulmonary valve, which may be present alongside transposition and can complicate the surgical repair.

2. Procedure

The surgical procedure for CPT® Code 33780 involves several critical steps to effectively repair the transposition of the great arteries and close the VSD:

• Accessing the Heart The procedure begins with either 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, which is often necessary for the subsequent steps of the procedure.
• 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 to assist in the repair of the VSD.
• 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 reconstruction.
• Cannulating the Aorta and Vena Cava The aorta and superior and inferior vena cava are cannulated to establish cardiopulmonary bypass, which is essential for maintaining circulation and oxygenation during the procedure.
• Cross-Clamping the Aorta The aorta is cross-clamped to control blood flow, allowing the surgeon to perform the necessary repairs in a bloodless field.
• Transecting the Aorta and Main Pulmonary Artery The ascending aorta and main pulmonary artery are transected to facilitate the reconstruction of the great vessels.
• Visualizing and Excising Coronary Artery Ostia The ostia of the left and right coronary arteries at the anomalous aortic root in the right ventricle are visualized and excised along with the adjacent aortic wall to prepare for their repositioning.
• Transferring Coronary Artery Ostia The coronary artery ostia are transferred as buttons to the newly created main pulmonary artery root sinuses in the left ventricle, ensuring proper blood supply to the heart muscle.
• Anastomosing the Distal Main Pulmonary Artery The distal main pulmonary artery and its branches are brought forward to the right ventricle, and the aorta is repositioned posteriorly to the left ventricle.
• Anastomosing the Distal Aorta The distal aorta is then anastomosed to the newly created aortic root in the left ventricle, completing the reconstruction of the aortic outflow tract.
• Anastomosing the Coronary Arteries The coronary arteries are also anastomosed to the newly created aortic outflow tract, ensuring adequate blood flow to the heart.
• Closing the Sternum After the repairs are completed, the sternum may be closed or left open, with the option to close it in a subsequent procedure if necessary. Chest tubes are placed as needed to manage any postoperative fluid accumulation.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring proper recovery. The sternum may be closed immediately or left open for later closure, depending on the surgeon's assessment. Patients typically require close observation in a critical care setting following the surgery. Chest tubes are placed to drain any excess fluid or air that may accumulate in the thoracic cavity. Recovery may involve pain management, monitoring of vital signs, and assessment of cardiac function. The surgical team will also evaluate the effectiveness of the VSD closure and the overall success of the transposition repair. Follow-up appointments will be necessary to monitor the patient's progress and address any potential complications.