33513 Coronary artery bypass, vein only; 4 coronary venous grafts

Name of the Procedure:

Coronary Artery Bypass Graft (CABG) Surgery, Vein Only; 4 Coronary Venous Grafts.

Summary

Coronary artery bypass graft surgery is a procedure to improve blood flow to the heart. Surgeons take a healthy vein from another part of the body and use it to bypass blocked or narrowed arteries in the heart, thereby improving blood circulation. This particular surgery involves creating four such venous grafts.

Purpose

The procedure addresses coronary artery disease (CAD) where one or more of the coronary arteries have significant blockage or narrowing. The goal is to enhance blood flow to the heart muscle, reduce chest pain (angina), prevent heart attacks, and improve the patient's quality of life.

Indications

• Severe chest pain (angina) not relieved by medications or other treatments
• Significant blockages in multiple coronary arteries
• Left main coronary artery disease
• Reduced heart function due to blocked arteries
• High risk of heart attack
• Unsuccessful previous angioplasty or stenting

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Certain medications might need adjustment or temporary discontinuation.
• Pre-operative assessments may include blood tests, an electrocardiogram (EKG), chest X-ray, and coronary angiography.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the chest and opens the ribcage to access the heart.
3. The heart may be stopped temporarily and connected to a heart-lung machine.
4. A vein, typically from the leg, is harvested.
5. The harvested vein is grafted onto the coronary artery, bypassing the blockage.
6. Four separate grafts are created to ensure improved blood flow.
7. The heart is restarted (if stopped), and the chest incision is closed.

Duration

The procedure typically takes 3 to 6 hours, depending on complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Cardiothoracic Surgeons
• Anesthesiologists
• Surgical Nurses
• Perfusionists (if heart-lung machine is used)

Risks and Complications

• Infection at the incision sites
• Bleeding
• Blood clots
• Heart attack or stroke
• Irregular heart rhythms (arrhythmias)
• Kidney dysfunction
• Cognitive changes or memory loss

Benefits

• Relief from chest pain
• Improved blood flow to the heart
• Higher energy and exercise tolerance
• Reduced risk of heart attack
• Enhanced quality of life

Recovery

• Hospital stay of 5-7 days, with initial care in the ICU.
• Gradual return to normal activities within 4-6 weeks.
• Restrictions on heavy lifting and strenuous activities for several weeks.
• Follow-up appointments for monitoring recovery progress.
• Participation in cardiac rehabilitation program recommended.

Alternatives

• Medical management with medications
• Percutaneous coronary intervention (PCI) with stenting
• Lifestyle modifications Each alternative has its pros and cons, and the best option depends on the patient's specific condition and overall health.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-surgery, there might be discomfort at incision sites and general fatigue. Pain management strategies including medications will be provided to ensure patient comfort. An individualized recovery plan will be followed to ensure successful rehabilitation.