CPT® Code 33391

Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex (eg, leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)

The procedure described by CPT® Code 33391 involves a complex valvuloplasty of the aortic valve, which is a critical surgical intervention performed to repair the aortic valve through an open chest incision while utilizing cardiopulmonary bypass. The aortic valve, situated between the left ventricle and the aorta, consists of three cusps or leaflets that regulate blood flow from the heart to the body. Over time, 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 between two ribs on the left side of the chest. The use of cardiopulmonary bypass is essential during this surgery; it 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. This allows for the heart to be temporarily stopped and cooled, facilitating the surgical repair of the valve. In the context of complex valvuloplasty, various techniques are employed to restore the function of the aortic valve. These may include leaflet extension, resection, reconstruction, or annuloplasty, each aimed at addressing specific structural issues with the valve. The complexity of the procedure necessitates careful planning and execution to ensure optimal outcomes for the patient.