The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Sutureless Aortic Valve Replacement for aortic stenosis.
Aortic stenosis occurs when the aortic valve, which separates the main pumping chamber of the heart from the blood circulation system of the body, becomes narrowed. This reduces the flow of blood out of the heart. During sutureless aortic valve replacement surgery, a cut is made in the chest to get to the heart. A heart–lung bypass machine takes over blood circulation during the operation and the heart is then stopped. The aortic valve is removed and replaced with an artificial valve (prosthesis) that is secured into place using no or minimal guiding sutures (stitches). The heart is then restarted and the cut in the chest is closed. Because the procedure can be done more quickly than traditional aortic valve surgery, less time is spent on the heart–lung bypass machine and side effects from the operation may be reduced.
One of the following OPCS-4 codes would be assigned:
K26.1 Allograft replacement of aortic valve
K26.2 Xenograft replacement of aortic valve
K26.3 Prosthetic replacement of aortic valve
K26.4 Replacement of aortic valve NEC
Y73.1 Cardiopulmonary bypass
If concurrent annuloplasty of aortic valve is also performed code this in addition using the following code:
K34.3 Annuloplasty of valve of heart NEC
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.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.