CPT® Code 33390

Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension)

The procedure described by CPT® Code 33390 refers to a surgical intervention known as aortic valvuloplasty, which is performed through an open chest incision while utilizing cardiopulmonary bypass. The aortic valve, which consists of three cusps or leaflets, serves as the critical outlet valve that regulates blood flow from the left ventricle into the aorta. Various factors such as infection, aging, and congenital defects can lead to the aortic valve becoming stiff and narrowed, a condition known as stenosis, which restricts blood flow. Alternatively, the leaflets may become loose and floppy, resulting in regurgitation, where blood flows back into the ventricle instead of moving forward into the aorta. To access the heart for this procedure, a surgeon typically makes an anterior midline incision in the chest, which involves opening the sternum, or alternatively, an intercostal incision may be made on the left side of the chest between two ribs to provide access. The procedure necessitates the use of cardiopulmonary bypass, which is initiated by placing a venous cannula in the right atrium, vena cava, or femoral vein, and an atrial cannula in the aorta, femoral or axillary artery, or apex of the heart. During the surgery, the heart is cooled, and muscle contractions are temporarily halted, often through the injection of a drug. For the simple valvuloplasty procedure, an incision is made in the heart to expose the aortic valve. If stenosis is present, the surgeon dilates and opens the commissures between the leaflets. Additionally, any calcium deposits or blood clots are removed through debridement or debulking. To address valvular regurgitation, simple commissural resuspension is performed using commissuroplasty techniques. This involves placing mattress sutures into the aorta to close the top 1 cm of the commissures, effectively narrowing the diameter of the valve orifice. This procedure is distinct from complex valvuloplasty, which involves more intricate repairs and modifications to the valve structure. Overall, CPT® Code 33390 encapsulates a critical surgical approach to restoring proper function to the aortic valve, thereby improving blood flow and cardiac efficiency.