33511 Coronary artery bypass, vein only; 2 coronary venous grafts

Name of the Procedure:

Coronary Artery Bypass Grafting (CABG), Vein Only; 2 Coronary Venous Grafts

Summary

Coronary Artery Bypass Grafting (CABG) is a surgical procedure aimed at improving blood flow to the heart. In this specific type, the surgeon uses veins from other parts of the body to bypass two blocked coronary arteries, facilitating improved blood flow to the heart muscle.

Purpose

This procedure is primarily performed to treat coronary artery disease (CAD). CAD occurs when the coronary arteries become narrowed or blocked due to atherosclerosis (buildup of plaques). The goal is to relieve symptoms like chest pain (angina), improve quality of life, reduce the risk of heart attacks, and increase life expectancy.

Indications

• Severe chest pain due to multiple coronary artery blockages
• Significant blockage in the left main coronary artery
• Unsuccessful relief from other treatments like medication or angioplasty
• Evidence of severe heart muscle dysfunction due to poor blood supply
• Need for revascularization without the option of stents

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustment or temporary discontinuation of certain medications
• Pre-operative tests including blood tests, chest X-ray, electrocardiogram (ECG), and coronary angiography
• Informing the healthcare team of any allergies or previous medical conditions

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incision: A median sternotomy is performed by making an incision along the breastbone.
3. Harvesting: Veins, typically the saphenous vein from the leg, are harvested.
4. Bypass Grafting: The surgeon attaches one end of the vein to the aorta and the other end to a point on the coronary artery beyond the blockage.
5. Repeat: This is repeated for the second coronary venous graft.
6. Closure: The chest incision is closed with sutures or staples, and the patient is taken off bypass, if used.

Duration

The procedure typically takes 3 to 6 hours, depending on complexity.

Setting

This surgery is performed in a hospital operating room equipped for cardiac surgery.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (if a heart-lung machine is used)
• Physician Assistants or Surgical Technicians

Risks and Complications

• Common: Infection, bleeding, arrhythmias, blood clots
• Rare: Stroke, heart attack, kidney failure, graft failure
• Management: Immediate medical intervention, medication adjustments, or additional surgical procedures may be required

Benefits

• Relief from chest pain and other symptoms of CAD
• Improved heart function and overall quality of life
• Reduced risk of heart attacks
• Potentially increased lifespan

Recovery

• Hospital stay of about 5-7 days, including time in ICU
• Pain management with prescribed medications
• Instructions for wound care, diet, and activity levels
• Follow-up appointments with the cardiologist
• Gradual return to normal activities in 6 to 12 weeks

Alternatives

• Medication management: Anti-anginal and cholesterol-lowering drugs
• Percutaneous Coronary Intervention (PCI): Angioplasty with stent placement
• Lifestyle changes: Diet, exercise, and smoking cessation
• Pros and cons: Medications and lifestyle changes are less invasive but may be less effective in severe cases compared to CABG; PCI is less invasive but may not be suitable for multiple or complex blockages.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. Post-operatively, the patient may experience pain at the incision site, which is managed with pain medications. Discomfort, fatigue, and limitations in physical activity are common during the initial recovery period, followed by gradual improvement over weeks to months.