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Code deleted. See 33390, 33391.

Official Description

Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 33403 refers to a valvuloplasty of the aortic valve, specifically utilizing a transventricular dilation approach while the patient is on cardiopulmonary bypass. In simpler terms, this surgical intervention aims to treat aortic stenosis, a condition characterized by the narrowing of the aortic valve opening, which impedes the flow of blood from the heart's left ventricle into the aorta. The aortic valve typically consists of three flexible leaflets that open and close to regulate blood flow. However, in cases of aortic stenosis, these leaflets may become thickened, less flexible, or even fused together, leading to significant obstruction. To perform this procedure, the surgeon gains access to the heart by making an incision in the sternum, allowing for a direct view and access to the heart's structures. Cardiopulmonary bypass is then initiated, which temporarily takes over the function of the heart and lungs, allowing the heart to be still and bloodless during the operation. The surgeon makes an incision in the apex of the left ventricle and introduces a series of dilators through the ventricle into the aortic valve. This dilation process aims to increase the diameter of the valve opening and separate any fused leaflets, thereby restoring normal blood flow. Once the valve is adequately dilated, the incision in the left ventricle is closed, and the cardiopulmonary bypass is discontinued. Finally, chest tubes may be placed to drain any excess fluid, and the chest is closed to complete the procedure.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure of aortic valvuloplasty using transventricular dilation is indicated for patients suffering from aortic stenosis. This condition is characterized by the following:

  • Aortic Stenosis - A narrowing of the aortic valve orifice that obstructs blood flow from the left ventricle into the aorta, leading to potential heart failure and other complications.
  • Thickened Leaflets - The valve leaflets may become thicker and less pliable than normal, impairing their ability to open fully during the cardiac cycle.
  • Fused Leaflets - In some cases, the leaflets may fuse together, further restricting blood flow and necessitating surgical intervention.

2. Procedure

The procedure involves several critical steps to ensure successful dilation of the aortic valve:

  • Accessing the Heart - The surgeon begins by making an incision in the sternum to gain access to the heart. This approach allows for a clear view of the heart's structures and facilitates the subsequent steps of the procedure.
  • Establishing Cardiopulmonary Bypass - Once access is achieved, cardiopulmonary bypass is initiated. This process temporarily takes over the functions of the heart and lungs, allowing the surgeon to operate on a still and bloodless field.
  • Cardioplegic Arrest - The heart is then placed in cardioplegic arrest, which involves administering a solution that temporarily stops the heart's activity, further ensuring a stable environment for the procedure.
  • Incision in the Left Ventricle - An incision is made in the apex of the left ventricle, providing a pathway for the dilators to access the aortic valve.
  • Dilation of the Aortic Valve - A series of dilators are carefully passed through the left ventricle and into the aortic valve. This step is crucial as it aims to increase the diameter of the valve opening and separate any fused leaflets, thereby alleviating the obstruction caused by aortic stenosis.
  • Closure of the Left Ventricle - Once the aortic valve is sufficiently dilated, the incision made in the left ventricle is closed securely to restore the integrity of the heart.
  • Discontinuation of Cardiopulmonary Bypass - After ensuring that the valve is functioning properly, the cardiopulmonary bypass is discontinued, allowing the heart to resume its normal function.
  • Placement of Chest Tubes - As needed, chest tubes are placed to facilitate the drainage of any excess fluid that may accumulate post-surgery.
  • Closure of the Chest - Finally, the chest is closed, completing the surgical procedure.

3. Post-Procedure

After the completion of the aortic valvuloplasty, patients typically require close monitoring in a recovery setting. Post-procedure care may include managing pain, monitoring vital signs, and ensuring that the heart is functioning effectively. Patients may also need to stay in the hospital for a few days to recover fully and to monitor for any potential complications. The placement of chest tubes will be assessed, and they will be removed once the drainage is deemed adequate. Follow-up appointments will be necessary to evaluate the success of the procedure and to monitor the patient's overall heart health.

Short Descr VALVULOPLASTY W/CP BYPASS
Medium Descr VLVP AORTIC VALVE W/TRANSVENTR DILAT W/CARD BYP
Long Descr Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 9 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE Not applicable/unspecified.
CCS Clinical Classification 43 - Heart valve procedures
Date
Action
Notes
2016-12-31 Deleted Code deleted. See 33390, 33391.
2011-01-01 Changed Short description changed.
1994-01-01 Added First appearance in code book in 1994.
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