CPT® Code 0452T

Deleted

Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; aortic counterpulsation device and vascular hemostatic seal

The procedure described by CPT® Code 0452T 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 device consists of a pneumatic pump that operates in conjunction with a console, which drives the pump using pressurized air. This system is synchronized with the patient's heartbeat through electrodes, allowing for precise timing in the device's operation. During ventricular systole, the pump fills, which effectively reduces the workload of the left ventricle by decreasing afterload. Conversely, during ventricular diastole, the pump ejects, thereby enhancing cardiac output and improving blood flow to both the coronary and systemic circulations. The procedure begins with an incision made in the right chest along the infraclavicular line, where the pump is placed into a subcutaneous pocket above the pectoralis muscle. The 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. Following the connection, air is evacuated from the system, and the device is activated. Electrocardiogram electrodes are positioned on the chest wall and connected to the console, or alternatively, mechano-electrical skin interface electrodes may be placed on the wrist, finger, or ankle to capture the heartbeat for synchronization. The surgical site is checked for any bleeding, and hemostatic sealing agents may be applied as necessary before closing the incisions. In cases where replacement of the device is required, a similar incision is made to expose the pump and vascular graft, allowing for the clamping, excision, and replacement of the device as per the original insertion procedure. This comprehensive approach ensures that the aortic counterpulsation device functions effectively to support the patient's cardiac function.