CPT® Code 33366

Transcatheter aortic valve replacement (TAVR/TAVI) is a minimally invasive surgical procedure designed to replace a stenotic (narrowed) aortic heart valve with a prosthetic valve. This procedure is performed through a transapical approach, which involves accessing the heart via a left thoracotomy and a stab incision at the apex of the heart. The left thoracotomy is typically performed at the sixth intercostal space, allowing the surgeon to reach the heart effectively. During the procedure, the pericardium, the protective sac surrounding the heart, is opened to gain access to the left ventricle. A needle puncture is made to enter the left ventricle, and this opening is gradually dilated to accommodate the introduction of a valve delivery catheter. The catheter is then carefully threaded over a guidewire, navigating through the left ventricle to the native aortic valve. To ensure proper pacing of the heart during the valve delivery, epicardial pacing wires may be placed on the left ventricle as needed. Prior to the placement of the prosthetic valve, the native aortic valve may be dilated using a balloon catheter to facilitate the deployment of the new valve. The compressed prosthetic valve, contained within a valve cage, is advanced over the guidewire to the site of the native aortic valve. Once positioned correctly, the valve is deployed, and the valve cage is subsequently removed. A balloon tip catheter is then utilized to properly seat the aortic valve by inflating it within the prosthetic valve. After confirming the position and function of the newly placed valve, the catheter is withdrawn, and the transapical puncture site, along with the chest incisions, are closed with sutures, completing the procedure.