33536 Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts

Name of the Procedure:

Coronary Artery Bypass Grafting (CABG) using arterial graft(s); 4 or more coronary arterial grafts. Commonly referred to as "heart bypass surgery."

Summary

Coronary artery bypass grafting (CABG) is a surgical procedure that improves blood flow to the heart. Surgeons use arteries from other parts of the body to bypass blocked coronary arteries, allowing improved blood flow to the heart muscle.

Purpose

CABG is performed to treat coronary artery disease (CAD). The goal is to relieve chest pain (angina), improve heart function, reduce the risk of heart attacks, and increase overall life expectancy.

Indications

• Severe chest pain due to multiple blocked coronary arteries.
• Blocked or narrowed arteries that affect the heart's main pumping chamber.
• Failed previous angioplasty or stent placements.
• Diagnosis of severe coronary artery disease from diagnostic tests like angiography.

Preparation

• Fasting for 8-12 hours before surgery.
• Adjustments to medications as advised, including blood thinners.
• Pre-operative tests such as blood work, chest X-ray, and electrocardiogram (ECG).
• Comprehensive medical history and physical examination.

Procedure Description

1. Anesthesia is administered, putting the patient under general anesthesia.
2. Surgeons make an incision in the chest and open the rib cage to access the heart.
3. Arteries are harvested from other parts of the body, often from the chest, arm, or leg.
4. The heart may be temporarily stopped, using a heart-lung machine to maintain blood and oxygen flow.
5. Surgeons attach the harvested arteries to bypass the blocked coronary arteries.
6. The heart is restarted, and the chest incision is closed with sutures or staples.

Duration

The procedure typically takes 3 to 6 hours.

Setting

Performed in a hospital with specialized cardiac surgery facilities.

Personnel

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

Risks and Complications

• Common: Infection, bleeding, arrhythmias.
• Rare: Stroke, heart attack, kidney failure.
• Management: Close monitoring in the ICU, medications, additional procedures if necessary.

Benefits

• Relief from chest pain (angina).
• Improved heart function and exercise tolerance.
• Reduced risk of heart attacks.
• Increased life expectancy and quality of life.

Recovery

• Hospital stay for 5-7 days post-surgery.
• Gradual increase in physical activity.
• Possible participation in a cardiac rehabilitation program.
• Full recovery may take 6-12 weeks, with restrictions on heavy lifting and strenuous activity.
• Follow-up appointments to monitor heart function and recovery progress.

Alternatives

• Medication management for coronary artery disease.
• Percutaneous coronary intervention (PCI) or angioplasty with stenting.
• Lifestyle changes including diet, exercise, and smoking cessation.
• Pros and Cons: Medications and lifestyle changes are less invasive but may not be sufficient for severe cases. PCI is less invasive but may not be suitable for multiple blockages.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel anything.
• Post-surgery, there may be pain and discomfort at the incision site, managed with pain medications.
• Fatigue, weakness, and soreness are common during initial recovery.
• Emotional support and rehabilitation programs can aid in recovery and overall well-being.