33517 Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure)

Name of the Procedure:

Coronary Artery Bypass Graft (CABG) using venous graft(s) and arterial graft(s); single vein graft

Summary

In layman's terms, Coronary Artery Bypass Grafting (CABG) is a surgery that improves blood flow to the heart. Surgeons use a vein from the leg and an artery from the chest to create a detour around a blocked coronary artery.

Purpose

The procedure is performed to treat coronary artery disease (CAD), which occurs when the coronary arteries become narrowed or blocked. The goals are to alleviate chest pain (angina), improve heart function, and reduce the risk of heart attacks.

Indications

• Severe chest pain due to blocked coronary arteries not relieved by other treatments
• Multiple narrowed coronary arteries
• A significant blockage in the left main coronary artery
• Heart function impairment due to insufficient blood flow

Preparation

• Fasting for at least 8 hours before the procedure
• Medications may need to be adjusted or stopped
• Routine blood tests, electrocardiogram (ECG), chest X-ray, and coronary angiography

Procedure Description

1. General anesthesia is administered.
2. The surgeon makes an incision in the chest to access the heart.
3. The heart is temporarily stopped, and a heart-lung machine takes over blood circulation.
4. A vein from the leg (typically the saphenous vein) and an artery from the chest (usually the internal mammary artery) are harvested.
5. The vein and artery are attached to the coronary arteries beyond the blocked section, creating a new path for blood flow.
6. The heart is restarted, and the chest is closed with sutures or staples.

Duration

The procedure typically takes 3 to 6 hours.

Setting

Performed in a hospital in a surgical operating room.

Personnel

• Cardiothoracic surgeon
• Surgical nurses
• Anesthesiologist
• Perfusionist (operates the heart-lung machine)

Risks and Complications

Common risks include:

• Bleeding
• Infection

• Blood clots

  Rare complications may include:

• Stroke
• Heart attack
• Kidney failure
• Respiratory complications

Benefits

Expected benefits include reduced chest pain, improved heart function, and a lower risk of heart attack. Benefits may be felt immediately but typically become more noticeable over weeks to months.

Recovery

• Post-procedure care includes monitoring in the ICU for 1 to 2 days.
• Hospital stay ranges from 5 to 7 days.
• Gradual return to normal activities over 6 to 12 weeks.
• Follow-up appointments for monitoring and rehabilitation.

Alternatives

• Medication management with statins, beta-blockers, and antiplatelets
• Percutaneous coronary intervention (PCI) or angioplasty
• Lifestyle changes involving diet, exercise, and smoking cessation

Pros and cons:

• Medications and PCI may be less invasive but not always as effective for severe cases.
• CABG usually offers better long-term outcomes for complex cases but involves higher surgical risks.

Patient Experience

Patients may experience discomfort and mild pain post-surgery, managed with medication. There will be physical restrictions initially, accompanied by a gradual increase in activity as healing progresses. Comfort measures and support from the healthcare team help manage the recovery process effectively.