Anesthesia for direct coronary artery bypass grafting; with pump oxygenator
CPT4 code
Name of the Procedure:
Anesthesia for Direct Coronary Artery Bypass Grafting; with Pump Oxygenator
Common Name: CABG with Cardiopulmonary Bypass, Open-Heart Bypass Surgery
Summary
Coronary Artery Bypass Grafting (CABG) is a surgical procedure where blood flow is redirected around blocked coronary arteries using a graft. This procedure uses a pump oxygenator to maintain circulation and oxygenation while the heart is stopped.
Purpose
Condition: Severe coronary artery disease, blockage of the coronary arteries
Goals: Restore blood flow to heart muscle, reduce symptoms of angina, prevent heart attacks, improve life expectancy
Indications
- Severe chest pain due to multiple blocked coronary arteries
- Blockage in the left main coronary artery
- Severe artery narrowing or blockage that hasn't improved with other treatments
- Unresponsive to other treatments like medication or angioplasty
Preparation
- Pre-procedure fasting (usually 8-12 hours before surgery)
- Stopping certain medications as directed by the physician
- Pre-surgical assessments like EKG, chest X-ray, blood tests, echocardiogram, and coronary angiogram
- Discussion of medical history and current medications with the healthcare team
Procedure Description
- Administering Anesthesia: General anesthesia is administered. Patient is put to sleep and remained unconscious for the duration of the surgery.
- Incision and Access: A large incision is made down the chest, and the breastbone is opened to access the heart.
- Cardiopulmonary Bypass: The heart is stopped, and a pump oxygenator (heart-lung machine) takes over the circulation and oxygenation of blood.
- Grafting: Healthy blood vessels (often taken from the leg, arm, or chest) are used to create bypasses around the blocked arteries.
- Completion: The heart is restarted, and the chest incision is closed with sutures or surgical staples.
Equipment Used: General anesthesia equipment, heart-lung machine, surgical instruments for grafting
Duration
The procedure typically takes between 3 to 6 hours.
Setting
Performed in a hospital, specifically in an operating room equipped for cardiac surgery.
Personnel
- Cardiothoracic Surgeon
- Anesthesiologist
- Surgical Nurses
- Perfusionist (operates the heart-lung machine)
- Surgical Technicians
Risks and Complications
Common Risks: Infection, bleeding, reactions to anesthesia, blood clots
Rare Risks: Stroke, heart attack, kidney failure, lung complications
Management: Close monitoring, medications, additional interventions if necessary
Benefits
- Relief from chest pain (angina)
- Increased physical activity tolerance
- Reduced risk of heart attack
- Improved quality of life and survival rates
Recovery
- Initial recovery in Intensive Care Unit (ICU) for close monitoring (1-2 days)
- Additional hospital stay of around 5-7 days
- Gradual return to normal activities within 6-8 weeks
- Follow-up appointments to monitor recovery
- Restrictions on heavy lifting and strenuous activities for several weeks
Alternatives
- Medication management
- Percutaneous coronary interventions (PCI), like angioplasty and stent placement
- Lifestyle changes, including diet and exercise modifications
Pros and Cons:
- Medications and PCI are less invasive but may not be as effective for severe blockages.
- CABG involves a longer recovery but offers substantial relief and improvement for severe cases.
Patient Experience
- During the Procedure: Patient is under general anesthesia and will not feel pain.
- Post-Procedure: Initial grogginess and soreness, particularly at the incision site; will be given pain management strategies and medications to ensure comfort.
- Hospital Stay: Will gradually resume eating, walking, and other activities under medical supervision.
- Recovery at Home: Will need assistance for daily tasks initially, follow a prescribed diet, and engage in cardiac rehabilitation exercises.
Pain management and careful monitoring will ensure a smoother recovery process.