CPT® Code 33860

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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.