02RG38H
Replacement Mitral Valve to Transapical with Zooplastic Tissue, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 2 Heart and Great Vessels |
| Operation | R Replacement |
| Body Part | G Mitral Valve |
| Approach | 3 Percutaneous |
| Device | 8 Zooplastic Tissue |
| Qualifier | H Transapical |
Operation Definition
Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Procedure Overview
Replacement procedures put in biological or synthetic material to physically take over for all or part of a heart valve, chamber wall, or great vessel segment that is diseased or damaged beyond simple repair. The most recognizable example is heart valve replacement, where a damaged aortic or mitral valve is taken out and substituted with a mechanical valve, a tissue valve from an animal or human donor, or, increasingly, a valve delivered through a catheter without open-heart surgery.
This family also includes replacing a diseased section of the aorta with a synthetic graft, as is done for an aneurysm or dissection. The underlying decision behind these procedures is that the native tissue can no longer perform its function safely, so a substitute structure is needed to physically stand in for it going forward.
Anatomy & Axis Detail
Mitral Valve
The mitral valve sits between the left atrium and left ventricle and normally prevents backflow during ventricular contraction, but myxomatous degeneration, rheumatic disease, ischemic dysfunction, or endocarditis can render the native valve unrepairable, necessitating replacement with a mechanical or bioprosthetic device. Surgeons generally prefer repair over replacement for the mitral valve when feasible, so replacement is typically reserved for leaflets too calcified, destroyed, or distorted to reconstruct. The procedure may be performed via open sternotomy, minimally invasive thoracotomy, or transcatheter mitral valve replacement in select high-risk patients. Because the subvalvular apparatus, including chordae and papillary muscles, is intimately connected to left ventricular geometry, preserving as much of this structure as possible during replacement helps maintain ventricular function, and documentation should note the device type and approach.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
Device: Zooplastic Tissue
Zooplastic Tissue designates material of animal origin, most often bovine or porcine, used to replace or reinforce human anatomic structures such as heart valves or grafts. It is procured from a non-human source and processed for implantation, setting it apart from autologous tissue taken from the patient's own body and from nonautologous tissue sourced from another human donor.
Qualifier: Transapical
This qualifier specifies a transapical route, accessing the heart directly through the ventricular apex, most often used for transcatheter valve procedures when standard vascular access is not feasible. It is distinguished from other access qualifiers such as transseptal or transaortic approaches, which reach the same target structure from a different starting point.
Coding & Documentation
Coding a Replacement case requires documentation confirming that the native structure was taken out (or was already absent, as in a redo procedure) and that a device or graft material now physically occupies that role. The material matters for the device value assigned - mechanical valve, tissue valve, synthetic vascular graft, and autologous tissue graft are all coded differently, so the operative note must specify what was implanted. A common error is coding Replacement when a valve is repaired with an annuloplasty ring rather than fully replaced, since a ring supports the native valve rather than substituting for it, which belongs under Repair or Supplement. Another pitfall is missing that a transcatheter valve replacement still qualifies as Replacement despite the minimally invasive approach, since the root operation depends on what was done, not how the access was gained.