CPT® Code 0451T

Deleted

Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; complete system (counterpulsation device, vascular graft, implantable vascular hemostatic seal, mechano-electrical skin interface and subcutaneous electrodes)

The procedure described by CPT® Code 0451T involves the insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system using an endovascular approach. This advanced medical intervention is designed to support patients with severe cardiac conditions, particularly those experiencing acute cardiogenic shock or end-stage chronic heart failure. The aortic counterpulsation system consists of several critical components, including a pneumatic pump that operates by utilizing pressurized air, a console that drives the pump, and electrodes that synchronize the device's operation with the patient's heartbeat. During the procedure, the pump fills with blood during ventricular systole, which reduces the workload of the left ventricle by decreasing afterload. Conversely, during ventricular diastole, the pump ejects blood, thereby enhancing cardiac output and improving both coronary and systemic blood flow. The insertion process begins with a surgical incision made in the right chest, specifically along the infraclavicular line, where the pump is placed into a subcutaneous pocket above the pectoralis muscle. A pneumatic drive line is then tunneled through the skin to the right upper quadrant of the abdomen, where it connects to the console. An interposition vascular graft is anastomosed to the subclavian artery, and the main graft is linked to the pump. After ensuring that air is removed from the system, the device is activated. Subcutaneous electrocardiogram electrodes are positioned on the chest wall and connected to the console, while mechano-electrical skin interface electrodes are placed on various locations such as the wrist, finger, or ankle to capture the heartbeat and synchronize the pump's function. The surgical team checks the graft site for any bleeding, and if necessary, implantable hemostatic sealing agents are applied before closing the incisions. In cases where a replacement of the device is required, the procedure involves making an incision to expose the existing pump, subclavian artery, and vascular graft. The device is clamped at the subclavian artery, excised, and replaced following the same steps as the initial insertion. CPT® Code 0451T encompasses the complete system, which includes the counterpulsation device, vascular graft, any vascular seal used, and the necessary electrocardiogram electrodes, along with the programming of sensing and therapeutic parameters.