CPT® Code 33411

Replacement of the aortic valve with aortic annulus enlargement of a noncoronary sinus is a surgical procedure aimed at addressing aortic annular hypoplasia, which may occur with or without accompanying aortic valve disease. This condition involves an underdeveloped aortic annulus, which can lead to significant cardiovascular complications. The procedure is typically performed through a median sternotomy or an upper hemisternotomy, allowing the surgeon access to the heart. During the operation, various cannulas are inserted to facilitate cardiopulmonary bypass, which is essential for maintaining blood circulation and oxygenation while the heart is temporarily stopped. The surgical technique involves making a transverse incision in the ascending aorta and performing meticulous dissection to enlarge the aortic annulus. This is achieved by separating the aorta's adventitia and the left atrial wall from the posterior aortic annulus, followed by resection of the posterior commissure. A synthetic patch is then utilized to close the defect created during the enlargement, and an aortic valve prosthesis is sutured in place. The procedure concludes with the closure of the aortic incision, removal of the cross-clamp, and careful weaning of the patient off cardiopulmonary bypass, ensuring that the heart resumes normal function. This complex surgical intervention is critical for patients suffering from severe left ventricular outflow tract obstruction (LVOTO) due to aortic annular hypoplasia, as it aims to restore normal hemodynamics and improve overall cardiac function.