CPT® Code 33992

Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion

The procedure described by CPT® Code 33992 involves the removal of a percutaneous left heart ventricular assist device (VAD), which is a mechanical pump used to support heart function and blood flow in individuals with weakened hearts. This specific code applies to the removal of the device, including any associated arterial or venous cannulae, and is performed at a separate and distinct session from the initial insertion of the device. Prior to the removal, the patient undergoes a process known as weaning, where the blood pump flow rate is gradually reduced in measured increments over several hours to ensure the patient's stability. Once the flow rate reaches the minimum threshold and the patient is deemed stable, the pump is turned off, and the VAD is carefully extracted. The exact steps taken during the removal process can vary based on the type of percutaneous VAD in place. For instance, if the VAD was inserted through the femoral artery into the left ventricle, the insertion site must be properly cleansed and prepped before the sutures are clipped, allowing for the catheter to be retracted from the left ventricle into the ascending aorta before complete withdrawal. The procedure also includes achieving hemostasis at the arterial access site, which may involve manual or mechanical compression, or a cutdown technique, followed by appropriate closure of the incision. In cases where the VAD is equipped with an external pump and involves both transseptal and femoral artery cannulas, the removal process entails clamping the cannulas, disconnecting the inflow and outflow lines from the pump, and subsequently removing the cannulas while applying compression to the puncture sites to ensure hemostasis.