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Code deleted, see 33858, 33859

Official Description

Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 33860 refers to a surgical procedure involving the repair of a thoracic aortic aneurysm specifically located in the ascending aorta. This procedure is performed using a graft and requires the use of cardiopulmonary bypass, which is a technique that temporarily takes over the function of the heart and lungs during surgery, allowing for a bloodless surgical field. The operation begins with a median sternotomy, a surgical incision made through the breastbone to provide access to the heart and ascending aorta. Once access is achieved, cardiopulmonary bypass is initiated, and the ascending aorta is cross-clamped to control blood flow. Following the induction of cardioplegic arrest, which is a method used to protect the heart during surgery by stopping its function, the ascending aorta is transected above the cross-clamp. In this procedure, the graft is carefully sized and modeled to fit the right cusp of the aortic valve, ensuring that it is positioned correctly within the chest. Sub-annular stitches are then passed through the graft and tied to secure it to the aortic annulus, which is the ring-like structure at the base of the aortic valve. A Hagar's dilator is utilized to accurately size the aortic annulus, and the aortic valve is thoroughly evaluated. If necessary, valve suspension is performed, which involves suspending the three commissures of the valve to maintain its proper function and positioning. This step requires meticulous attention to detail to avoid any distortion of the aortic valve leaflets. After confirming the proper functioning of the valve, the distal portion of the graft is sewn to the remaining normal ascending aorta. The procedure concludes with the evacuation of air from the heart, removal of the cross-clamp, and reperfusion of the heart. If required, temporary pacing wires are placed to assist with heart rhythm management. Finally, cardiopulmonary bypass is terminated, all cannulas are removed, drains are placed, and the chest is closed. This comprehensive approach ensures the successful repair of the ascending aorta while addressing any potential complications related to the aortic valve.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 33860 is indicated for the repair of a thoracic aortic aneurysm located in the ascending aorta. This condition may present with various symptoms or complications, necessitating surgical intervention to prevent life-threatening events such as aortic dissection or rupture. The following are specific indications for performing this procedure:

  • Thoracic Aortic Aneurysm: A localized dilation of the ascending aorta that poses a risk of rupture or dissection.
  • Cardiovascular Compromise: Symptoms indicating potential cardiovascular instability due to the aneurysm, such as chest pain or shortness of breath.
  • Progressive Aneurysm Growth: Evidence of increasing size of the aneurysm on imaging studies, which may warrant surgical intervention.

2. Procedure

The procedure for CPT® Code 33860 involves several critical steps to ensure the successful repair of the ascending aorta. Each step is detailed as follows:

  • Step 1: Median Sternotomy - The surgeon begins by making a median sternotomy, which is an incision through the breastbone. This provides direct access to the heart and ascending aorta, allowing for the necessary surgical intervention.
  • Step 2: Initiation of Cardiopulmonary Bypass - Once access is achieved, cardiopulmonary bypass is initiated. This involves connecting the patient to a heart-lung machine that takes over the function of pumping blood and oxygenating it, allowing the surgeon to operate on a still and bloodless field.
  • Step 3: Cross-Clamping the Ascending Aorta - The ascending aorta is then cross-clamped to control blood flow during the procedure. This step is crucial for isolating the area of repair.
  • Step 4: Cardioplegic Arrest - The heart is then placed in cardioplegic arrest, which is achieved by administering a solution that temporarily stops the heart's function. This protects the heart during the surgical repair.
  • Step 5: Transection of the Ascending Aorta - The ascending aorta is transected above the cross-clamp, allowing for the removal of the aneurysmal segment and preparation for graft placement.
  • Step 6: Graft Sizing and Modeling - A graft is sized and modeled to correspond to the right cusp of the aortic valve. This ensures that the graft will fit properly within the chest cavity.
  • Step 7: Securing the Graft - Sub-annular stitches are passed through the graft and tied to secure it to the aortic annulus, which is the area surrounding the aortic valve.
  • Step 8: Aortic Annulus Sizing - A Hagar's dilator is used to accurately size the aortic annulus, ensuring that the graft is appropriately fitted.
  • Step 9: Evaluation of the Aortic Valve - The aortic valve is evaluated for any dysfunction. If valve suspension is necessary, the three commissures of the valve are suspended to maintain proper positioning and function.
  • Step 10: Testing the Aortic Valve - The valve is tested to confirm that it is functioning properly after the suspension procedure.
  • Step 11: Sewing the Distal Graft - The distal portion of the graft is sewn to the remaining normal ascending aorta, completing the connection.
  • Step 12: Reperfusion and Closure - Air is evacuated from the heart, the cross-clamp is removed, and the heart is reperfused. Temporary pacing wires are placed if needed, and cardiopulmonary bypass is terminated. Finally, all cannulas are removed, drains are placed, and the chest is closed.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored in a recovery area or intensive care unit for any complications. Post-procedure care includes monitoring vital signs, managing pain, and ensuring proper heart function. Patients may require temporary pacing to support heart rhythm until it stabilizes. The surgical site will be assessed for any signs of infection or complications. Drains placed during the procedure will be monitored and managed as necessary. The expected recovery period may vary based on the patient's overall health and the complexity of the surgery, but close follow-up with the surgical team is essential to ensure optimal recovery and address any concerns that may arise.

Short Descr ASCENDING AORTIC GRAFT
Medium Descr ASCENDING AORTA GRF W/CARD BYP & VALVE SSP
Long Descr Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed
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 09 - 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 52 - Aortic resection, replacement or anastomosis
Date
Action
Notes
2019-12-31 Deleted Code deleted, see 33858, 33859
2011-01-01 Changed Long description revised. Medium description changed.
2010-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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