CPT® Code 33268

Exclusion of left atrial appendage, open, performed at the time of other sternotomy or thoracotomy procedure(s), any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) (List separately in addition to code for primary procedure)

The procedure described by CPT® Code 33268 involves the open exclusion of the left atrial appendage (LAA), which is a small pouch located in the left atrium of the heart. This procedure is typically indicated for patients suffering from non-valvular atrial fibrillation (NVAF) who are at an elevated risk for thrombus formation or stroke, particularly when oral anticoagulation therapy is not a viable option. The primary goal of this surgical intervention is to completely close off or remove the LAA to prevent it from accumulating blood and forming clots, which can lead to serious complications such as stroke. The exclusion of the LAA can be performed using various surgical techniques, including excision, isolation via stapling, oversewing, ligation, plication, or the application of a clip. The choice of method may depend on the specific anatomical characteristics of the LAA, which can vary significantly among individuals. The LAA can be classified into four distinct morphological groups, including the 'chicken wing' type, which has a bend in the proximal end of the dominant lobe; the 'windsock' type, characterized by a long main lobe; the 'cauliflower' type, which has a limited length and lacks forked lobes; and the 'cactus' type, featuring a dominant central lobe with secondary extensions. Additionally, the anatomical configuration of the ostium and neck of the LAA can influence the surgical approach, as these structures may differ in size and shape. Factors such as the pressure or loading status of the heart and the presence of sinus rhythm or atrial fibrillation also play a critical role in determining the most appropriate closure technique. It is important to note that CPT® Code 33268 is specifically used when the LAA exclusion is performed concurrently with another open cardiac procedure, distinguishing it from CPT® Code 33267, which is used when the LAA exclusion is the sole procedure conducted during the surgical encounter.