CPT® Code 33928

A total replacement heart system (total artificial heart, TAH) is a sophisticated mechanical device designed to replace both ventricles of the heart. This system utilizes polyurethane structures and disc valves, which are connected to an external pumping drive, to mimic the function of a natural heart. The TAH serves as a critical intervention for patients with severe heart failure, acting as a bridge to transplantation until a suitable donor heart becomes available. The procedure for implanting a TAH involves a median sternotomy, which is a surgical incision made through the breastbone to access the heart. During this operation, the left diaphragm is carefully divided and dissected to create a peritoneal pocket in the upper left abdomen, allowing for the placement of the device's components. Additionally, incisions are made to create tunnels for the pneumatic drive lines that connect the artificial heart to the external pump. The surgical process includes cannulation of the aorta and vena cavae to establish heart-lung bypass, followed by the excision of the patient's ventricles and the meticulous preparation of the remaining cardiac structures to accommodate the new device. The procedure is complex and requires precise surgical techniques to ensure proper placement and function of the TAH, ultimately aiming to restore adequate blood circulation in patients with terminal heart disease.