Archived Policies - Surgery


Partial Left Ventriculectomy (PLV)

Number:SUR707.019

Effective Date:06-01-2008

End Date:11-14-2010

Coverage:

This policy is no longer scheduled for routine literature review and update.

Partial left ventriculectomy is considered experimental, investigational, and unproven.

Description:

Partial left ventriculectomy (PLV) is a surgical procedure aimed at improving the hemodynamic status of patients with end-stage (irreversible) heart failure by directly reducing left ventricular size.  This is accomplished by reducing cardiac volume and left ventricular wall tension through resection of the posterolateral wall of the left ventricle.  This surgical approach to the treatment of heart failure (also known as the Batista procedure, cardio-reduction, or left ventricular remodeling surgery) is primarily directed at patients with an underlying dilated cardiomyopathy awaiting cardiac transplantation.  PLV has been investigated as a “bridge” or an alternative to transplantation.

Rationale:

This policy is based on a 1998 Blue Cross and Blue Shield Association Technology (TEC) Assessment, which concluded that the available data were inadequate to permit conclusions regarding health benefits associated with partial left ventriculectomy.  Specifically, the TEC Assessment concluded that the lack of any controlled comparison of PLV to medical therapies or other types of “bridge to transplantation” (i.e., ventricular assist devices) made scientific assessment of the efficacy of PLV impossible, either in its role as a potential bridge to transplant or as an adjunct to medical therapy.

In addition, in 1997, the Society of Thoracic Surgeons issued a policy statement recommending that PLV be considered an investigational procedure, and that it should not be used as a primary strategy for the management of end-stage congestive heart failure.

A search of the literature based on the MEDLINE database from the period of 1998 to July 2004 did not identify any published articles that would change the above conclusions.  As an example of the published literature, Franco-Cereceda and colleagues reported on the one-year and three-year outcomes of 62 patients with dilated cardiomyopathy who underwent partial left ventriculectomy.   At the time of surgery all patients were either in New York Heart Association functional class III or IV.  Survival was 80% and 60% at one and three years after surgery, and freedom from failure was 49% and 26%, respectively.  Although 80% of the patients were alive at one year, this survival was achieved with the aggressive use of ventricular assist devices and transplantation as a salvage therapy.  The authors concluded that partial left ventriculectomy is not a predictable, reliable alternative to transplantation.  Further investigations may be warranted, focusing on the use of the procedure as a bridge to transplant, or its use in those not considered candidates for transplantation.  In 2003, the results of the Third International Registry Report were published, including data through 2002.  This report noted that the incidence of left ventriculectomy reached a peak by 1998 and was largely abandoned by 2000, except in Asia, where experienced institutions continue to perform the procedure in patients in better condition with preserved myocardial contractility.

A further search of the MEDLINE database through November 2006 did not identify any new evidence in the peer-reviewed medical literature that:

  • permits conclusions on the effect of PLV on health outcomes.
  • demonstrates an improvement in net health outcome through use of PLV.  
  • demonstrates that use of PLV is as beneficial as established alternatives.

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:

This procedure should be billed using CPT code 33999.  CPT codes 33542 and 33548 are not the same as PLV and should not be used to bill for PLV.


Medicare Coverage:

The information contained in this section is for informational purposes only.  HCSC makes no representation as to the accuracy of this information.  It is not to be used for claims adjudication for HCSC Plans.

The Centers for Medicare and Medicaid Services (CMS) does have a national Medicare coverage position.

A national coverage position for Medicare may have been developed or changed since this medical policy document was written.  See Medicare's National Coverage at <http://www.cms.hhs.gov>.

References:

Committee on New Technology Assessment, The Society of Thoracic Surgeons.  Left ventricular reduction surgery.  Annals of Thoracic Surgery (1997) 63(3):909-10.

CMS—National Coverage Determination for partial left vewntriculectomy (20.26).  Centers for Medicare and Medicaid Services.  (1997 April) <http://www.cms.hhs.gov>.

Partial Left Ventriculectomy.  Chicago, Illinois: Blue Cross Blue Shield Association –Technology Evaluation Center Assessment Program (1998) Tab 4.

Franco-Cereceda, A., McCarthy, P.M., et al.  Partial left ventriculectomy for dilated cardiomyopathy: is this an alternative to transplantation?  Journal of Thoracic Cardiovascular Surgery (2001) 121(5):879-93.

Kawaguchi, A.T., Isomura, T., et al.  Partial left ventriculectomy – The Third International Registry Report 2002.  Journal of Cardiac Surgery (2003) 18(suppl 2):S33-S42.

Partial left ventriculectomy (the Batista procedure).  Interventional Procedure Guidance 41, National Institute for Clinical Excellence.  (2004 February) <http://www.nice.org.uk>.

Kawaguchi, A.T., Takeshita, N.  Angiographic and hemodynamic follow-up of patients after partial left ventriculectomy.  Journal of cardiac Surgery (2005 November-December) 20(6):S35-8.

Shimura, S., Kawaguchi, A.T., et al.  Partial left ventriculectomy in elderly patients not suitable for heart transplant.  Journal of Cardiac Surgery (2005 November-December) 20(6):S25-8.

Wilhelm, M.J., Hammel, D., et al.  Partial left ventriculectomy and mitral valve repair: favorable short-term results in carefully selected patients with advanced heart failure due to dilated cardiomyopathy.  Journal of Heart and Lung Transplantation (2005 November) 24(11):1957-64.

Policy History:

6/1/2008          Policy reviewed without literature review; new review date only.  This policy is no longer scheduled for routine literature review and update.

5/1/2007          Revised/updated entire document

1/1/1999          New medical document

Archived Document(s):

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