Coronary artery bypass, vein only; 3 coronary venous grafts
CPT4 code
Name of the Procedure:
Coronary Artery Bypass, Vein Only; 3 Coronary Venous Grafts
Common Name(s): Heart Bypass Surgery, CABG Surgery
Medical Term: Coronary Artery Bypass Grafting (CABG)
Summary
Coronary artery bypass grafting (CABG) is a surgical procedure used to improve blood flow to the heart. During this procedure, a surgeon uses veins from other parts of the body to create new pathways (grafts) for blood to flow around blocked or narrowed coronary arteries. In this case, three coronary venous grafts are used.
Purpose
CABG addresses coronary artery disease, a condition where the heart's arteries are blocked or narrowed due to plaque buildup. The procedure aims to restore adequate blood flow to the heart, reduce chest pain (angina), minimize the risk of heart attack, and improve overall heart function and quality of life.
Indications
- Severe chest pain due to multiple blocked coronary arteries
- Blockages or narrowing in the left main coronary artery
- Previous heart interventions, such as angioplasty, that were unsuccessful
- Poor heart function caused by narrowed arteries
- Patients with diabetes who have extensive artery blockages
Preparation
- Fasting for at least 8 hours before the procedure
- Adjustments in medications as advised by the doctor
- Pre-operative blood tests, electrocardiogram (ECG), and imaging tests such as coronary angiography
- Evaluation of overall health to assess suitability for surgery
Procedure Description
- Administering general anesthesia to ensure the patient is asleep and pain-free.
- Making an incision down the middle of the chest and splitting the breastbone to access the heart.
- Connecting the patient to a heart-lung machine to maintain blood circulation and oxygenation during the surgery.
- Harvesting veins from the patient’s leg or other suitable sites.
- Suturing the harvested veins to the coronary arteries, bypassing the blocked sections.
- Re-starting the patient's heart and disconnecting from the heart-lung machine.
- Closing the breastbone with wires and suturing the chest incision.
Duration
The procedure typically takes 3 to 6 hours.
Setting
Performed in a hospital operating room, usually followed by a stay in the intensive care unit (ICU).
Personnel
- Cardiac Surgeon
- Anesthesiologist
- Surgical Nurses
- Perfusionist (manages the heart-lung machine)
- Scrub Technicians
Risks and Complications
- Infection at the incision sites
- Bleeding
- Blood clots leading to stroke or heart attack
- Irregular heart rhythms (arrhythmias)
- Kidney dysfunction
- Respiratory complications
Benefits
- Relief from chest pain (angina)
- Lowered risk of heart attack
- Improved heart function
- Enhanced quality of life and exercise capacity
- Long-term survival benefits
Recovery
- Hospital stay of 5 to 7 days post-surgery
- Initial rest and gradual increase in physical activity
- Pain management with prescribed medications
- Restrictions on heavy lifting and strenuous activities for several weeks
- Follow-up appointments for monitoring and cardiac rehabilitation
Alternatives
- Percutaneous Coronary Intervention (PCI) such as angioplasty with stenting
- Medication management (e.g., anti-angina drugs, statins)
- Lifestyle modifications (diet, exercise, smoking cessation)
- Each alternative has its own set of benefits and limitations compared to surgical bypass.
Patient Experience
- Patients typically experience some pain and discomfort after surgery, which is managed with pain relief medications.
- Feeling of tightness or soreness in the chest and along the vein harvesting sites.
- Emotional support and counseling may be needed due to stress and anxiety associated with major surgery.
- Rehabilitation and gradual return to normal activities are encouraged to promote recovery and mental well-being.