CPT® Code 33783

Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); with reimplantation of 1 or both coronary ostia

The Nikaidoh procedure, designated by CPT® Code 33783, is a complex surgical intervention aimed at correcting specific congenital heart defects, particularly those involving transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS). This procedure is essential for patients who present with these intricate cardiac anomalies, as it addresses the abnormal connections and flow of blood within the heart. The surgery involves a median sternotomy, which is a surgical incision made along the sternum to provide access to the heart and surrounding great vessels. During the operation, a patch graft is harvested from the pericardium, the fibrous sac surrounding the heart, to aid in the reconstruction of the heart's anatomy. To facilitate the procedure, cardiopulmonary bypass is initiated through bicaval cannulation, allowing the heart to be temporarily stopped while blood is diverted through a heart-lung machine. Cardioplegia, a method used to induce temporary cardiac arrest, is then administered to protect the heart muscle during the surgery. The surgical steps include mobilizing the proximal coronary arteries, incising the right ventricle, and separating the aortic root from the right ventricle. The pulmonary artery is transected, and the infundibular septum is divided to allow for proper alignment and connection of the heart structures. The posterior aspect of the aortic root is sutured to the pulmonary valve annulus, while the anterior aspect is sutured over the ventricular septal defect, effectively closing the defect and redirecting blood flow. The ascending aorta is then transected, a small section is removed, and the aorta is reconfigured to prevent any bowing that could affect blood flow. A LeCompte maneuver is performed to reposition the ascending aorta behind the pulmonary artery, ensuring optimal anatomical alignment. Finally, the transected ends of the ascending aorta are sutured together, and a pericardial patch graft is utilized to reconstruct the right ventricular outflow tract, enlarging the hypoplastic main pulmonary artery to improve blood flow. This procedure is critical for restoring normal hemodynamics in patients with these congenital heart defects.