33533 Coronary artery bypass, using arterial graft(s); single arterial graft

Name of the Procedure:

Coronary Artery Bypass, using arterial graft(s); single arterial graft. Common name: CABG using single arterial graft.

Summary

Coronary artery bypass grafting (CABG) using a single arterial graft is a surgical procedure to improve blood flow to the heart. This involves taking a healthy artery from another part of the body and attaching it to the blocked coronary artery, bypassing the blockage.

Purpose

This procedure is primarily used to treat coronary artery disease (CAD), where plaque buildup narrows the coronary arteries and reduces blood flow to the heart muscle. The goal is to relieve symptoms like chest pain, reduce the risk of a heart attack, and improve overall heart function.

Indications

• Severe chest pain due to CAD that doesn't respond to other treatments.
• Multiple blocked coronary arteries.
• Blockage of the left main coronary artery.
• Failed percutaneous coronary intervention (e.g., angioplasty).

Preparation

• Fast for 8-12 hours before surgery.
• Discontinue certain medications as directed, especially blood thinners.
• Preoperative tests include blood work, electrocardiogram (ECG), chest X-ray, and coronary angiography.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A sternotomy (chest incision) is made to access the heart.
3. Graft Harvesting: An artery, often the internal mammary artery, is harvested.
4. Bypass Creation: The harvested artery is grafted to bypass the blocked coronary artery.
5. Attachment: One end of the graft is attached to the aorta and the other to the blocked coronary artery, rerouting blood flow.
6. Closure: The sternum is wired back together and the incision is closed.

Special tools: Surgical instruments for sternotomy and graft attachment, heart-lung machine (if on-pump technique is used).

Duration

The procedure typically takes 3-6 hours.

Setting

Performed in a hospital operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (if heart-lung machine is used)

Risks and Complications

Common risks: Infection, bleeding, reaction to anesthesia. Rare risks: Stroke, heart attack, kidney failure. Management: Monitoring in intensive care unit (ICU), medications, possible additional surgeries.

Benefits

• Relief from chest pain.
• Improved heart function.
• Lower risk of future heart attacks.
• Enhanced quality of life. Benefits are typically realized within a few weeks to months post-surgery.

Recovery

• Initial recovery in ICU for monitoring.
• Hospital stay of 5-7 days.
• Avoid strenuous activities for 6-8 weeks.
• Follow-up appointments for ongoing care and monitoring.
• Cardiac rehabilitation may be recommended.

Alternatives

• Percutaneous Coronary Intervention (PCI) such as angioplasty or stenting.
• Medications to manage symptoms and slow disease progression.
• Lifestyle changes (diet, exercise).

Pros and cons: PCI is less invasive but may not be suitable for multiple or complex blockages. Medications and lifestyle changes require consistent management and may not be effective alone.

Patient Experience

During: The patient will be under general anesthesia and feel no pain. After: Pain at the incision site, managed with pain medication. Comfort measures: Pain management, support from healthcare team, gradual increase in activity levels.