CPT® Code 33140

Transmyocardial laser revascularization (TMR or TMLR) is a surgical procedure designed to enhance blood flow to the myocardium, which is the muscular tissue of the heart. This procedure is executed through an open approach, typically involving a thoracotomy, which is an incision made in the chest wall to access the heart. During TMR, general anesthesia is administered to ensure the patient is unconscious and pain-free throughout the operation. A double lumen endotracheal tube is inserted to facilitate ventilation of the right lung, thereby providing optimal exposure of the heart for the surgeon. The surgical team may choose to perform either a midline sternotomy, which involves splitting the breastbone, or an anterolateral thoracotomy, which is an incision made on the side of the chest. Once the chest is opened, the pericardium, the protective sac surrounding the heart, is incised to allow direct access to the heart muscle. The procedure utilizes a laser, which is precisely calibrated in terms of energy level and pulse duration. A laser probe is then positioned over the left ventricle, making contact with the epicardium, the outer layer of the heart. With the assistance of a computer, the laser beam is accurately directed to specific areas of the heart, and the laser is activated between heartbeats to minimize damage to the surrounding tissues. The laser creates small channels, approximately one millimeter in diameter, that extend from the surface of the heart into the internal ventricular chamber. This process is repeated multiple times, typically between 20 to 40 times, to ensure adequate revascularization. After the channels are created, they usually close quickly on the external surface of the heart. However, if there is persistent bleeding from the epicardial surface, local pressure or sutures may be applied to control it. The channels formed within the left ventricle remain open, allowing oxygen-rich blood to flow through them as the left ventricle contracts and pumps blood into the aorta, thereby restoring blood flow to the heart muscle. Upon completion of the TMR procedure, the pericardium is reapproximated, and one or more chest tubes are placed in the pericardial cavity to facilitate drainage and prevent fluid accumulation. It is important to note that CPT® Code 33140 should be used when TMR is performed as a standalone procedure, while CPT® Code 33141 is applicable when TMR is conducted concurrently with another open cardiac procedure.