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

1. Administering Anesthesia: General anesthesia is administered. Patient is put to sleep and remained unconscious for the duration of the surgery.
2. Incision and Access: A large incision is made down the chest, and the breastbone is opened to access the heart.
3. Cardiopulmonary Bypass: The heart is stopped, and a pump oxygenator (heart-lung machine) takes over the circulation and oxygenation of blood.
4. Grafting: Healthy blood vessels (often taken from the leg, arm, or chest) are used to create bypasses around the blocked arteries.
5. 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.