Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Coronary Artery Bypass Grafting (CABG) using venous and arterial grafts; 3 venous grafts
Summary
In a coronary artery bypass grafting procedure, also known as CABG, surgeons use both venous and arterial grafts to bypass blocked coronary arteries. This specific procedure involves using three venous grafts in addition to one or more arterial grafts to improve blood flow to the heart muscle.
Purpose
CABG addresses severe coronary artery disease (CAD), a condition where the coronary arteries are narrowed or blocked, limiting blood flow to the heart. The procedure aims to relieve chest pain, improve quality of life, reduce the risk of heart attacks, and increase life expectancy.
Indications
- Severe chest pain (angina) that does not respond to medication
- Multiple coronary artery blockages
- Blockages in the left main coronary artery or multiple vessels
- Emergency intervention following a heart attack
- Reduced heart function due to narrowed arteries
Preparation
- Patients are generally advised to fast for at least 8 hours before the procedure.
- No smoking for at least 24 hours prior.
- Medication adjustments, especially if anticoagulants are being taken.
- Preoperative tests such as EKG, chest X-ray, blood tests, and possibly a coronary angiogram.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A midline incision is made along the chest, and the sternum is split to access the heart.
- Harvesting Grafts: The saphenous vein from the leg (venous graft) and internal mammary artery (arterial graft) are harvested.
- Connection: These grafts are then connected to the coronary arteries beyond the blockages. In this case, three venous grafts are used.
- Bypass Machine: A heart-lung bypass machine may be used to circulate blood and oxygen during the surgery.
- Closure: The sternum is wired back together and the incision is closed with sutures or staples.
Duration
The procedure typically lasts 3 to 6 hours.
Setting
CABG is performed in a hospital's operating room, often requiring a stay in the intensive care unit (ICU) post-operation.
Personnel
- Cardiothoracic Surgeon
- Anesthesiologist
- Surgical Nurses
- Perfusionist (operates the heart-lung machine)
- Physician Assistants
- Supporting healthcare staff
Risks and Complications
- Infection
- Bleeding
- Stroke
- Heart attack
- Graft failure
- Arrhythmias
- Kidney failure
- Reaction to anesthesia
Benefits
- Significant relief from chest pain (angina)
- Improved heart function
- Decreased risk of future heart attacks
- Enhanced quality of life
- Increased survival rate
Recovery
- Monitoring in the ICU for the first 24-48 hours.
- Hospital stay typically lasts 5-7 days.
- Gradual return to normal activities over 6-12 weeks.
- Activity restrictions and lifestyle modifications.
- Follow-up appointments to monitor recovery and heart function.
Alternatives
- Medication management (e.g., nitrates, beta blockers, statins)
- Percutaneous Coronary Intervention (PCI) with stent placement
- Lifestyle changes (diet, exercise, smoking cessation)
- Each alternative has variable success rates and potential risks/benefits.
Patient Experience
Patients generally experience significant pain and discomfort immediately after the procedure, which is managed with pain relief medications. As recovery progresses, discomfort decreases, and patients can expect a gradual return to daily activities and improved cardiac symptoms.