CPT® Code 33440

Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (Ross-Konno procedure)

The procedure described by CPT® Code 33440 involves the replacement of the aortic valve through a specialized surgical technique known as the Ross-Konno procedure. This complex operation is primarily indicated for patients suffering from multilevel left ventricular outflow tract obstruction (LVOTO), which can arise from various congenital heart defects such as severe annular hypoplasia, dysplastic aortic valves, and diffuse subaortic narrowing. LVOTO is frequently associated with Shone’s syndrome, particularly following the primary repair of an interrupted aortic arch (IAA) or in cases of congenital valve stenosis. The surgical approach requires opening the chest and establishing cardiopulmonary bypass to facilitate a safe and controlled environment for the procedure. The aorta is cross-clamped and partially transected to allow for a thorough examination of the aortic valve, while the pulmonary artery is also transected to assess the pulmonary valve. The procedure includes the harvesting of the pulmonary autograft, which is then utilized to replace the aortic valve, along with necessary modifications to the left ventricular outflow tract to ensure proper blood flow and function. This intricate surgical intervention aims to alleviate the obstruction and restore normal hemodynamics in the heart, ultimately improving the patient's quality of life and long-term outcomes.