CPT® Code 33851

1. Indications

The procedure described by CPT® Code 33851 is indicated for patients diagnosed with coarctation of the aorta, which may present with various symptoms and conditions. The following are explicitly provided indications for performing this surgical intervention:

• Coarctation of the Aorta - A congenital narrowing of the aorta that leads to differential blood flow between the upper and lower body.
• Patent Ductus Arteriosus - The presence of an open ductus arteriosus that may accompany the coarctation, necessitating surgical intervention.

2. Procedure

The surgical procedure for CPT® Code 33851 involves several critical steps to effectively excise the coarctation and repair the aorta. Each step is detailed as follows:

• Step 1: Accessing the Aorta - The procedure begins with a posterolateral thoracotomy, which involves making an incision in the chest wall to gain access to the thoracic cavity. The parietal pleura, a membrane lining the chest wall, is incised to expose the underlying structures.
• Step 2: Exposing the Aorta - Through careful dissection of the surrounding tissues, the surgeon exposes the transverse aortic arch, left subclavian artery, ligamentum or ductus arteriosus, descending aorta, and intercostal collateral vessels. This meticulous dissection is essential for visualizing the coarctation site and surrounding anatomy.
• Step 3: Controlling Blood Flow - Proximal and distal control of the aorta is achieved using vascular clamps to prevent blood loss during the excision. The subclavian artery is also clamped, and vessel loops are used to control the intercostal collaterals, ensuring a clear surgical field.
• Step 4: Managing the Patent Ductus Arteriosus - If a patent ductus arteriosus is present, it is controlled with transfixing sutures, and a stay suture is placed in the aortic isthmus to facilitate subsequent steps. The ductus is then ligated to prevent blood flow through this vessel.
• Step 5: Resection of the Coarctation - The narrowed segment of the aorta is resected, which involves removing the constricted portion of the vessel. This step is critical for alleviating the obstruction and restoring normal blood flow.
• Step 6: Repairing the Aorta - Following resection, the repair is performed using either patch aortoplasty or left subclavian flap aortoplasty. In patch aortoplasty, a synthetic patch is trimmed and sutured in place to enlarge the aorta, while in left subclavian flap aortoplasty, a flap is created from the proximal subclavian artery to cover the resected area.
• Step 7: Closing the Surgical Site - After the repair is completed, the parietal pleura is closed over the patch or flap. The chest incisions are then closed, and chest tubes may be placed as needed to facilitate drainage and prevent fluid accumulation.

3. Post-Procedure

Post-procedure care following the excision of coarctation of the aorta involves monitoring the patient for any complications and ensuring proper recovery. Patients may require observation in a critical care setting initially, where vital signs and hemodynamic status are closely monitored. Pain management is also an essential aspect of post-operative care. The surgical site will be assessed for signs of infection or complications, and chest tubes, if placed, will be monitored for drainage. Patients are typically advised on activity restrictions and follow-up appointments to evaluate the success of the procedure and the need for any further interventions. Overall, the recovery process is individualized based on the patient's condition and response to surgery.