The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on thoracoscopic aortopexy for severe primary tracheomalacia in December 2007. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in February 2011 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.

Description

Tracheomalacia is a weakness and floppiness of the main airway (the trachea) and may cause breathing difficulties. It usually presents at birth but may develop later in life. Aortopexy involves attaching the aorta to the sternum with sutures. This pulls the front wall of the trachea forwards to prevent it from collapsing. The thoracoscopic procedure is performed using special instruments inserted through several small incisions in the chest and with the help of a camera ('keyhole' surgery).

Coding recommendations

L25.8 Other specified other open operations on aorta

Y74.2 Thoracoscopic approach to thoracic cavity NEC

Note: OPCS-4 codes B18.9 Unspecified excision of thymus gland and Y05.2 Partial excision of organ NOC are assigned in addition if part of the thymus gland is excised.

This would also be recorded with the ICD-10 code Q32.0 Congenital tracheomalacia.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.