post op pt w/ hemotoma and heart wall repair

Good afternoon,

I have a return to the OR for a post op hemorraghe/hemotoma and attempted repair of the AV groove. I am having trouble finding a CPT for this surgery. Pt is post aortic valve replacement with dark bloody output from the chest tube.

She was taken to the OR for mediastinal explaration. Once open the surgeon found well, here is the report.

The sternal wires were removed with a wire cutter and a chest spreader was put in place; significant bloody drainage was evacuated and clot. After its evacuation, the patient had a significant drop in her blood pressure down to the 20s and during this drop to the 20s anesthesia gave the patient some epinephrine and there was a huge swing in blood pressure up to the 200s to 240s. With this, as the heart was being lifted, the left lateral wall in the circumflex distribution, there was a significant dehiscence of the heart and a significant hole in the heart at the atrioventricular groove. With this significant blood loss, the patient was emergently placed on bypass. An Ethibond suture was put in the aorta, the heparin was given, the aortic cannula was placed and hooked up and the patient was placed on sucker bypass once the ACT was appropriate. With sucker bypass, after maintaining some type of control, an Ethibond was placed in the right atrium and a right atrial two-stage venous cannula was put in place; this was put in line and the patient was placed on routine bypass. At this point, the patient had fairly adequate drainage. ...

Now, with the patient on bypass and controlled bypass, the patient was arrested with cardioplegia after crossclamping the aorta in the usual fashion. Now, inspecting the lateral wall, the entire lateral wall was extremely friable and unable to hold sutures adequately. Numerous attempts using 3-0 Prolene suture and felt pledgets were undertaken in addition; this tissue still continued to bleed. Attempts were made to place bovine pericardium and use Dermabond at points to try to build up tissue in the area to allow for adequate suture in order to hold the tissue appropriately. Significant thought was given throughout the case to open the left atriotomy and repair the AV groove dehiscence from the inside. ... at no point was the bleeding adequately controlled. Finally, obtaining some sense of repair at the lateral wall with no significant oozing, the attempt was made to come off the bypass machine. The patient came off the bypass machine appropriately; however, ripped this lateral wall further and bleeding once again continued. Numerous rounds of blood, FFP and platelets were given. Patient at this point, after approximately 8 hours, began to become coagulopathic. Despite attempts and lengthy discussion with the family, attempt was still made to try to wean the patient from bypass after controlling the bleeding at the AV groove. Additional sutures were thrown; this too was unsuccessful. Attempt was made, again, to wean the patient from bypass, patient just could not wean from bypass as ongoing bleeding was barely being kept up with the bypass machine.

What CPT code has I missed or should I go with an unlisted code for this case?
Thank you in advance for your help.
Margaret

post op pt w/ hemotoma and heart wall repair