CPT® Code 0259T

Deleted

Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; with cardiopulmonary bypass

The procedure described by CPT® Code 0259T involves a transthoracic cardiac exposure for the replacement of a stenotic aortic heart valve with a prosthetic valve. This replacement is achieved through a catheter-delivered method, which allows for less invasive access to the heart compared to traditional surgical techniques. The term "transthoracic" refers to the approach taken to access the heart, which can be through a sternotomy (opening the chest through the breastbone), thoracotomy (opening the chest through the side), or subxiphoid (accessing the heart from below the xiphoid process). During this procedure, the pericardium, the protective sac surrounding the heart, is incised to allow for direct access. If the procedure is performed without the use of cardiopulmonary bypass, which is indicated by CPT® Code 0258T, epicardial pacing wires are placed on the left ventricle to facilitate pacing of the heart during the valve delivery. However, when cardiopulmonary bypass is utilized, as indicated by CPT® Code 0259T, specific cannulation techniques are employed. A venous cannula is inserted into the right atrial appendage, and an arterial cannula is placed in the ascending aorta to manage blood flow during the procedure. Additionally, a cardioplegia cannula is introduced into the coronary sinus through a stab incision in the right atrium, and another cannula is positioned in the ascending aorta to deliver cardioplegic solution, which temporarily stops the heart to allow for a safe surgical environment. A left ventricular vent is also placed in the right superior pulmonary vein to assist in managing the heart's function during the procedure. Once cardiopulmonary bypass is established and cardioplegic arrest is initiated, a small incision is made in the aorta or left ventricle to facilitate the introduction of the catheter and the collapsed prosthetic aortic valve. The native aortic valve may be dilated using a balloon catheter to ensure proper placement of the prosthetic valve. The prosthetic valve is then positioned within the native valve and deployed, followed by the use of a balloon catheter to secure its placement. To confirm the correct positioning and functionality of the prosthetic valve, contrast is injected, and angiograms are obtained. After the procedure, if cardiopulmonary bypass was used, the aortic cross clamp is removed, and the patient is gradually weaned off bypass. Finally, chest tubes may be placed as necessary, and the chest incision is closed to complete the procedure.