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An aortopexy, also known as aortic suspension, is a surgical procedure aimed at decompressing the trachea, particularly in cases of tracheomalacia. Tracheomalacia is characterized by a weakness in the cartilage that supports the trachea, leading to a widening of the posterior membranous wall. This condition can result in the trachea collapsing, which may cause significant respiratory difficulties for the patient. The procedure is performed through a left anterior thoracotomy, which involves making an incision in the chest to access the aorta. During the surgery, the thymus gland is resected, and the apex of the left upper lobe of the lung is retracted to provide better visibility and access to the aorta. Care is taken to avoid dissection of the aorta from the surrounding tissues to minimize complications. A single row of sutures is then placed through the aorta at the aortic arch, ensuring that the sutures penetrate deep enough to include the media and adventitia layers of the aorta. These sutures are subsequently passed to the undersurface of the sternum, anchoring the aorta in place. Alternatively, the sutures may be passed through the sternum to a subcutaneous pocket and tied off. This anchoring technique displaces the aortic arch anteriorly, effectively pulling the anterior wall of the trachea forward, which helps to prevent tracheal collapse and alleviates the associated respiratory issues.
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The aortic suspension (aortopexy) procedure is indicated for patients experiencing tracheomalacia, which is characterized by the following conditions:
The aortopexy procedure involves several critical steps to ensure effective tracheal decompression:
After the aortopexy procedure, patients typically require monitoring for any complications related to the surgery. Expected recovery may involve a hospital stay for observation, pain management, and respiratory support as needed. The surgical site will need to be monitored for signs of infection or other complications. Follow-up appointments will be necessary to assess the success of the procedure and the patient's respiratory function. Additional considerations may include rehabilitation to strengthen respiratory muscles and improve overall lung function.
| Short Descr | AORTIC SUSPENSION | Medium Descr | AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX | Long Descr | Aortic suspension (aortopexy) for tracheal decompression (eg, for tracheomalacia) (separate 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | 61 - Other OR procedures on vessels other than head and neck |
This is a primary code that can be used with these additional add-on codes.
| 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) | 33258 | 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), without cardiopulmonary bypass (List separately in addition to code for primary procedure) |
| 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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