CPT® Code 0458T

Official Description

Removal of permanently implantable aortic counterpulsation ventricular assist system; subcutaneous electrode

Common Language Description

The procedure described by CPT® Code 0458T involves the removal of a permanently implantable aortic counterpulsation ventricular assist system, specifically focusing on the subcutaneous electrode component. This system is utilized primarily in the management of acute cardiogenic shock or end-stage chronic heart failure. Its function is to alleviate the workload of the left ventricle while enhancing cardiac output and blood flow, which is critical in patients experiencing severe heart conditions. The aortic counterpulsation device comprises several key components, including a pneumatic pump, a console that operates the pump using pressurized air, and electrocardiogram electrodes that synchronize the device's operation with the patient's heartbeat. The pump is surgically placed in a subcutaneous pocket located above the pectoralis muscle, with a pneumatic drive line exiting through the skin in the right upper abdomen to connect to the console. An interposition vascular graft is surgically anastomosed to the subclavian artery, allowing for the main graft to connect to the pump. Additionally, subcutaneous electrocardiogram electrodes are strategically positioned on the chest wall and linked to the console, while mechano-electrical skin interface leads are placed over various arteries, such as the radial artery at the wrist, the digital artery at the finger, or the posterior tibial artery at the ankle, to effectively capture the heartbeat and ensure synchronization with the pump's operation. During the removal procedure, an incision is made to access the pump, vascular graft, pneumatic drive tubing, and any present subcutaneous electrodes. The device is clamped at the subclavian artery, the vascular graft is excised, and the artery is repaired. The pneumatic drive tubing and subcutaneous electrode are then disconnected from the console, allowing for the complete removal of the device. This procedure is critical for patients who no longer require the assistive device or who may be transitioning to other forms of treatment.

1. Indications

The removal of a permanently implantable aortic counterpulsation ventricular assist system, specifically the subcutaneous electrode, is indicated in the following scenarios:

Acute Cardiogenic Shock - This condition necessitates the use of the device to support cardiac function, and its removal may be required when the patient's condition stabilizes or improves.
End-Stage Chronic Heart Failure - Patients with this diagnosis may have the device implanted to enhance cardiac output; however, removal may be indicated if the patient transitions to other treatment modalities or if the device is no longer effective.

2. Procedure

The procedure for the removal of the subcutaneous electrode of the aortic counterpulsation ventricular assist system involves several critical steps:

Step 1: Incision - A surgical incision is made in the skin to access the implanted device. This incision is carefully placed to allow for optimal exposure of the pump and associated components.
Step 2: Exposure - The incision is extended to expose the pump, the subclavian artery, the vascular graft, the pneumatic drive tubing, and the subcutaneous electrodes. This step is crucial for ensuring that all components can be safely removed.
Step 3: Clamping the Device - The device is clamped at the subclavian artery to prevent any blood loss during the removal process. This step is essential for maintaining hemostasis.
Step 4: Excision of the Vascular Graft - The vascular graft is excised from the subclavian artery. This involves careful dissection to ensure that surrounding tissues are preserved as much as possible.
Step 5: Repair of the Subclavian Artery - After the graft is removed, the subclavian artery is repaired using clips or sutures to restore normal blood flow and integrity to the vessel.
Step 6: Disconnection of Tubing and Electrodes - The pneumatic drive tubing is disconnected from the console, and the subcutaneous electrode is also removed. This step completes the disconnection of the device from the patient.
Step 7: Removal of the Entire Unit - Finally, the entire unit, including the subcutaneous electrode, is removed from the surgical site, concluding the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as bleeding or infection at the incision site. Patients may require follow-up appointments to assess recovery and ensure that the subclavian artery has healed properly. Pain management may also be necessary, and patients should be advised on activity restrictions during the initial recovery phase. Additionally, any changes in the patient's cardiac status should be closely monitored, as the removal of the device may impact their overall heart function.

Short Descr	REMVL SUBQ ELECTRODE
Medium Descr	REMVL PERM IMPLT AORTIC VENTR SUBQ ELECTRODE
Long Descr	Removal of permanently implantable aortic counterpulsation ventricular assist system; subcutaneous electrode
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	T-Packaged Codes
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.