CPT® Code 33853

1. Indications

The procedure is indicated for the following conditions:

• Hypoplastic Aortic Arch A condition characterized by a narrowing of the aorta along the entire arch, which can lead to inadequate blood flow and associated complications.
• Interrupted Aortic Arch A congenital defect where a segment of the aortic arch is completely absent, resulting in a critical interruption of blood flow to the body.
• Associated Cardiac Anomalies The repair may also be indicated in patients with other congenital heart defects such as ventricular septal defect (VSD), patent ductus arteriosus (PDA), aortopulmonary window, and truncus arteriosus, which may complicate the management of the aortic arch conditions.

2. Procedure

The surgical procedure for repairing a hypoplastic or interrupted aortic arch involves several critical steps:

• Accessing the Aortic Arch A posterolateral incision is made to provide access to the aortic arch. The parietal pleura is incised to facilitate exposure of the underlying structures.
• Mobilization of Aortic Structures The ascending aorta, aortic arch, and its branches, along with the ductus arteriosus and descending aorta, are carefully mobilized to allow for adequate surgical intervention. This step is crucial for ensuring that all affected areas can be addressed during the repair.
• Protection of Vital Nerves During the procedure, care is taken to protect the recurrent laryngeal and phrenic nerves, which are essential for normal respiratory function and vocal cord movement.
• Control of Lymphatic Vessels Lymphatic vessels in the area are controlled using hemoclips to prevent any potential complications related to lymphatic leakage.
• Ligation of Ductus Arteriosus The ductus arteriosus is ligated to isolate the segment of the aorta that requires repair.
• Establishing Cardiopulmonary Bypass If the procedure is performed with cardiopulmonary bypass, the aorta and superior and inferior vena cava are cannulated, and bypass is established. The aorta is then cross-clamped to facilitate the repair.
• Repair of the Aortic Arch The hypoplastic or interrupted segment of the aortic arch is repaired using either a patch graft or a tubular graft. In patch aortoplasty, a longitudinal incision is made beyond the narrowed section, and a synthetic patch is trimmed and sutured in place, ensuring the widest portion is at the narrowest segment of the arch. Alternatively, a tube graft may be used to replace the missing segment, or an autogenous graft, such as a left subclavian artery flap graft, may be employed.
• Closure of the Surgical Site After the repair is completed, the parietal pleura is closed over the graft, and the chest incisions are closed. Chest tubes may be placed as needed to facilitate drainage and prevent fluid accumulation.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the surgery, such as bleeding or infection. Patients may require intensive care for a period following the operation, especially if cardiopulmonary bypass was utilized. Recovery will include pain management, respiratory support, and gradual mobilization. The placement of chest tubes will be monitored to ensure proper drainage, and follow-up imaging may be necessary to assess the integrity of the repair and the overall function of the aorta. The healthcare team will provide specific instructions regarding activity restrictions and follow-up appointments to ensure optimal recovery.