33518 Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure)

Name of the Procedure:

Coronary Artery Bypass Grafting (CABG) with Venous and Arterial Grafts; 2 Venous Grafts

Summary

Coronary Artery Bypass Grafting (CABG) is a surgical procedure used to improve blood flow to the heart. In this procedure, blood vessels (grafts) taken from other parts of the body are used to bypass blocked or narrowed arteries in the heart. Specifically, this version of the procedure includes using both venous and arterial grafts, involving two venous grafts.

Purpose

CABG is performed to treat severe coronary artery disease (CAD), where one or more of the coronary arteries are blocked. The goal is to alleviate chest pain (angina), improve survival rates, and enhance the quality of life by restoring adequate blood flow to the heart muscle.

Indications

• Severe chest pain due to blocked coronary arteries
• Significant narrowing or blockage of key coronary arteries
• Failed response to other treatments like medication or angioplasty
• High risk of heart attack due to arterial blockages
• Coronary artery disease with left ventricular dysfunction

Preparation

• Fasting: Patients will need to fast for 8-12 hours before the procedure.
• Medication Adjustments: Certain medications may need to be stopped or adjusted.
• Diagnostic Tests: Blood tests, electrocardiograms (EKG), and imaging tests like a coronary angiogram will be required to plan the surgery.

Procedure Description

1. Anesthesia: The patient will be under general anesthesia.
2. Incision: A large incision is made in the chest to access the heart.
3. Harvesting Grafts: Blood vessels are taken from the leg (saphenous vein) for the venous grafts and from the chest or arm (internal mammary artery) for the arterial grafts.
4. Bypass: The grafts are sewn onto the coronary arteries, bypassing the blocked sections.
5. Closure: The incisions are closed, and the patient is moved to a recovery area.

Tools/Technology Used:

• Surgical instruments for cutting and suturing
• Heart-lung machine (cardiopulmonary bypass)
• Monitoring equipment

Duration

The surgery typically lasts between 3 to 6 hours, depending on the complexity and number of grafts needed.

Setting

The procedure is performed in a hospital, specifically in the cardiovascular surgical suite.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates the heart-lung machine)
• Cardiologist (for pre- and post-surgical care)

Risks and Complications

• Common Risks: Infection, bleeding, blood clots
• Rare Risks: Stroke, heart attack, renal failure
• Management: Close monitoring, medications, and possibly additional surgical interventions

Benefits

• Alleviation of chest pain
• Improved heart function and oxygen supply
• Increased survival rates
• Enhanced quality of life

Recovery

• Post-Procedure: Intensive care unit (ICU) stay for monitoring, followed by a hospital stay of about a week.
• Instructions: Wound care, medication regimen, gradual increase in activity
• Recovery Time: Full recovery may take 6-12 weeks, with follow-up appointments to monitor progress.

Alternatives

• Medications: Beta-blockers, nitrates, statins
• Non-Surgical: Angioplasty with stent placement
• Pros/Cons: Medications may be less invasive but might not be as effective for severe blockages; angioplasty is less invasive but may not be suitable for multiple or complex blockages.

Patient Experience

• During Procedure: The patient will be under general anesthesia and not feel any pain.
• After Procedure: Pain at incision sites, soreness, and discomfort managed with pain medications. Patients will experience gradual improvement in energy levels and reduction in symptoms over weeks to months.