Archived Policies - Surgery


Dynamic Cardiomyoplasty

Number:SUR707.005

Effective Date:04-01-1999

End Date:01-31-2007

Coverage:

Dynamic Cardiomyoplasty is not eligible for coverage as it is considered investigational.

Description:

DYNAMIC CARDIOMYOPLASTY is a supplement/alternative to medical therapy or as alternative/bridge to heart transplantation for patients with congestive heart failure. The surgical procedure uses a skeletal muscle graft from the abdomen which is wrapped around the failing heart for reinforcement. A Cardiomyostimulator (pacemaker-like device), is used to electrostimulate the skeletal muscle graft and condition it to induce fatigue resistance. This conditioning process usually lasts between two and three months. The skeletal muscle is eventually paced in synchrony with the patient's heart.

The Cardiomyostimulator has not yet received FDA approval. Therefore, dynamic cardiomyoplasty is only offered in the context of an FDA investigational device exemption (IDE) trial.

Rationale:

None

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

None


Medicare Coverage:

None

References:

Journal of Cardiac Surgery (1996 May-June) 11(3): pages 194 - 199.

"Dynamic Cardiomyoplasty," The Heart Surgery Forum, (on-line [08/12/98] - http://hsforum.com/HEARTSURGERY/ScrubSink/Myoplasty.hsf) 08/08/95.

Journal of Rehabilitation Research and Development (1996 April) 33(2): pages 133 - 144.

Journal of the American College of Cardiology (1996 November 1) 28(5): pages 1175 - 1180.

Current Opinion in Cardiology (1997 March) 12(2): pages 166 - 171.

Journal of Heart-Lung Transplant (1997 June) 16(6): pages 585 - 595.

AACN Clinical Issues (1998 May) 9(2): pages 192 - 207.

"Dynamic Cardiomyoplasty," Medtronic, Product Information, (on-line [08/12/98] - http://www.medtronic.com/cardiomyoplasty) 1998.

BCBSA Consortium Health Plan Medical Policy Reference Manual, Dynamic Cardiomyoplasty, Surgery,01/16/98, policy number 7.01.60.

Journal of Cardiac Failure (1998 March) 4(1): pages 57 - 66.

Annals of Thoracic Surgery (1998 May) 65(6): pages 1231 - 1234.

Policy History:

Archived Document(s):

Title:Effective Date:End Date:
Dynamic Cardiomyoplasty10-15-201709-30-2018
Dynamic Cardiomyoplasty10-01-201610-14-2017
Dynamic Cardiomyoplasty02-01-201609-30-2016
Dynamic Cardiomyoplasty09-15-201401-31-2016
Dynamic Cardiomyoplasty10-15-201309-14-2014
Dynamic Cardiomyoplasty03-15-200810-14-2013
Dynamic Cardiomyoplasty02-01-200703-14-2008
Dynamic Cardiomyoplasty04-01-199901-31-2007
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