2025 CPT code 33440
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Replacement of the aortic valve using the patient's own pulmonary valve, with enlargement of the aortic annulus of the left ventricular outflow tract (LVOT), and replacement of the translocated pulmonary valve with a valved conduit (Ross-Konno procedure).
Modifiers may be used as needed to indicate add-on procedures or other necessary clarifications.Modifier 51 might be used for multiple procedures during the same session.
The Ross procedure is medically necessary for patients with severe aortic stenosis who are unsuitable for traditional prosthetic valve replacement due to factors such as age, life expectancy, or the presence of other cardiac conditions. The procedure aims to provide a more durable and physiologically advantageous alternative to prosthetic valves.
The cardiac surgeon is responsible for the entire procedure, from pre-operative assessment and planning to post-operative care. This includes all aspects of the surgical technique, management of cardiopulmonary bypass, and addressing any complications.Anesthesiologists and other supporting medical personnel are also involved in the care of the patient during the procedure.
In simple words: The surgeon replaces the heart's aortic valve with the patient's own pulmonary valve.They make the opening for the valve larger and then use a special tube with a valve to replace the moved pulmonary valve. This is a complex heart surgery.
This procedure involves replacing the aortic valve with the patient's own pulmonary valve.The surgeon enlarges the aortic annulus of the left ventricular outflow tract (LVOT) to accommodate the translocated pulmonary valve.The translocated pulmonary valve is then replaced with a valved conduit. The procedure includes median sternotomy, cannulation of the aorta and venae cavae, cardiopulmonary bypass, aortic cross-clamping, cardioplegia administration, pulmonary artery division and inspection, pulmonary valve excision and trimming, aortic valve excision, coronary artery ostia mobilization, aortic annulus incision and enlargement, pulmonary autograft sizing and anastomosis to the LVOT, coronary artery ostia anastomosis to the pulmonary artery, distal pulmonary artery anastomosis to the aorta, RVOT reconstruction using a valved conduit, and closure of the sternotomy incision.
Example 1: A 55-year-old patient with severe aortic stenosis and a bicuspid aortic valve is a candidate for the Ross procedure.The patient has no significant comorbidities. , A 48-year-old patient with a history of rheumatic heart disease presents with severe aortic stenosis and moderate aortic regurgitation. The Ross procedure is planned, considering the patient's relatively young age and the potential for long-term durability. The surgeon assesses the suitability of the patient's pulmonary valve for transplantation., A 60-year-old patient with bicuspid aortic valve and a history of Marfan syndrome requires aortic valve replacement.Due to the patient's connective tissue disorder, a Ross procedure is deemed inappropriate, and a mechanical or biological prosthetic valve is selected instead.
Detailed pre-operative evaluation including echocardiography, cardiac catheterization, and assessment of pulmonary valve suitability. Intraoperative records documenting all steps of the procedure. Post-operative echocardiography, cardiac monitoring, and assessment of valve function.
** The Ross procedure is a complex and technically demanding operation.Careful patient selection and experienced surgical teams are essential for successful outcomes.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Cardiothoracic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center