Insertion of graft, aorta or great vessels; with cardiopulmonary bypass
CPT4 code
Name of the Procedure:
Insertion of graft, aorta or great vessels; with cardiopulmonary bypass (also known as Aortic Graft Surgery, Aortic Replacement, or Vascular Graft Surgery with Bypass)
Summary
Aortic graft surgery involves placing a synthetic tube (graft) into the aorta or its major branches to treat areas that are damaged or diseased. During the procedure, the heart and lungs are supported by a cardiopulmonary bypass machine, allowing surgeons to work on a non-beating heart.
Purpose
This procedure addresses severe aortic aneurysms, dissections, or blockages. The goal is to replace or bypass the damaged segment, restoring normal blood flow and preventing life-threatening complications like rupture or embolism.
Indications
- Large or symptomatic aortic aneurysm
- Aortic dissection
- Severe aortic occlusive disease
- Traumatic injury to the aorta or great vessels
- Congenital aortic abnormalities
Preparation
- Patients may need to fast for 8-12 hours before the procedure.
- Certain medications, especially blood thinners, may need to be adjusted.
- Pre-procedure diagnostic tests might include blood tests, echocardiogram, CT scans, or angiography.
- Consent forms and pre-operative briefings are also provided.
Procedure Description
- General anesthesia is administered to the patient.
- An incision is made in the chest or abdomen, depending on the targeted site.
- The patient is connected to a cardiopulmonary bypass machine to maintain circulation and oxygenation.
- The damaged section of the aorta or vessel is identified and clamped.
- Surgeons remove the affected segment and replace it with a synthetic graft, suturing it into place.
- The heart is restarted, and the patient is gradually taken off bypass support.
- Incisions are closed, and postoperative monitoring begins.
Duration
The procedure typically lasts between 4-8 hours, depending on complexity.
Setting
This surgery is performed in a hospital operating room equipped with cardiac surgery facilities.
Personnel
- Cardiothoracic surgeons
- Vascular surgeons
- Anesthesiologists
- Surgical nurses
- Perfusionists (professionals operating the cardiopulmonary bypass machine)
Risks and Complications
- Bleeding
- Infection
- Complications from anesthesia
- Stroke or heart attack
- Graft leakage or failure
- Organ dysfunction due to reduced blood flow during surgery
- Kidney failure
Benefits
- Relief from symptoms like chest pain or difficulty breathing
- Prevents life-threatening events like aneurysm rupture or aortic dissection
- Improved blood flow and cardiovascular function
- Increased lifespan and quality of life post-recovery
Recovery
- Intensive care unit (ICU) stay for monitoring, typically 1-3 days
- Hospital stay for about 5-10 days
- Gradual return to normal activities within 6-8 weeks
- Follow-up appointments for imaging and health assessments
- Restrictions on heavy lifting and strenuous activities for several weeks
Alternatives
- Endovascular aortic repair (EVAR)
- Medical management for smaller or less symptomatic aneurysms
- Lifestyle modifications and pharmacological therapy Pros of alternatives:
- EVAR is less invasive with shorter recovery.
- Medical therapy is non-invasive but may not prevent aneurysm growth. Cons of alternatives:
- EVAR might not be suitable for all patients.
- Medical management may only be a temporary measure.
Patient Experience
During the procedure, the patient will be under anesthesia and hence will not feel anything. Post-operatively, patients may experience discomfort, pain at the incision site, and will be closely monitored for complications. Pain management includes medications, and patients are encouraged to engage in light activities as advised by healthcare providers. Comfort measures like pillows, warm blankets, and controlled breathing exercises can aid recovery.