CPT® Code 33300

The procedure described by CPT® Code 33300 involves the repair of a cardiac wound without the use of cardiopulmonary bypass, commonly referred to as off-pump cardiac wound repair. This surgical intervention is necessary when there is a breach in the cardiac tissue, which can occur due to trauma or surgical complications. The process begins with the opening of the chest cavity to gain access to the heart, allowing the surgeon to control any bleeding and assess the extent of the cardiac injury. During this procedure, blood is evacuated from the thoracic cavity to provide a clear view of the surgical site. The pericardium, which is the fibrous sac surrounding the heart, may be incised to facilitate the drainage of any fluid accumulation in the pericardial cavity. To stabilize the heart during the repair, an apical traction suture, also known as a Beck's suture, is placed. This technique allows the surgeon to manipulate the heart while it continues to beat, which is crucial for identifying the exact location and severity of the wound. If the cardiac wound is small, bleeding can often be managed through direct digital pressure or temporary suturing. In cases where more significant bleeding occurs, a Foley catheter may be utilized; it is inserted through the wound into the cardiac chamber, and its balloon is inflated with normal saline to occlude the wound and reduce blood loss. For larger wounds, the surgical team may clamp the inferior and superior vena cava to create a bloodless field, enabling a more thorough evaluation of the wound and any potential damage to surrounding structures, including coronary arteries. Once the bleeding is controlled and no further injuries are detected, the wound is permanently closed using mattress sutures reinforced with pledgets to ensure stability and minimize the risk of future complications. Throughout the procedure, careful attention is paid to avoid damaging the coronary vessels. After the repair is completed, the traction suture is removed, and chest tubes may be placed as necessary before closing the chest cavity.