CPT® Code 0453T

Deleted

Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; mechano-electrical skin interface

The procedure described by CPT® Code 0453T 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 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 pump's operation. During ventricular systole, the pump fills, which 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 circulation. 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. A pneumatic drive line is then tunneled through the skin to the right upper quadrant of the abdomen, connecting to the console. The interposition vascular graft is anastomosed to the subclavian artery, and the main graft is linked to the pump. After the system is assembled, air is evacuated, and the device is activated. Electrocardiogram electrodes are strategically positioned on the chest wall and connected to the console, or mechano-electrical skin interface electrodes are placed on the wrist, finger, or ankle to capture the heartbeat and synchronize the pump's function. The surgical site is monitored for bleeding, and hemostatic sealing agents may be applied as needed before closing the incisions. In cases where replacement of the device is necessary, a similar incision is made to access the pump and vascular graft, allowing for the clamping, excision, and replacement of the device as initially inserted. This procedure is critical for patients requiring mechanical support for their heart function, providing a means to improve hemodynamic stability and overall patient outcomes.