33521 Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure)

Name of the Procedure:

Coronary artery bypass graft surgery (CABG) with venous and arterial grafts; 4 venous grafts.

Summary

Coronary artery bypass graft (CABG) surgery is a procedure to improve blood flow to the heart. Surgeons use veins from another part of the body (usually the leg) and arteries to bypass blocked or narrowed coronary arteries.

Purpose

Medical Conditions Addressed:

• Blocked or narrowed coronary arteries
• Coronary artery disease (CAD)

Goals and Outcomes:

• Restore adequate blood flow to the heart
• Reduce symptoms like chest pain (angina)
• Lower the risk of heart attacks
• Improve overall heart function and quality of life

Indications

Symptoms or Conditions:

• Severe chest pain (angina) not relieved by medication
• Severe narrowing or blockage of coronary arteries
• Damaged or weakened heart muscle (e.g., after a heart attack)
• Impaired quality of life due to heart disease

Patient Criteria:

• Patients with multi-vessel coronary artery disease
• Patients who have not responded to other treatments (e.g., medication, angioplasty)
• Patients with suitable veins or arteries for grafting

Preparation

• Fasting from midnight before the surgery
• Stopping certain medications as instructed by your doctor
• Pre-operative tests: blood tests, chest X-ray, electrocardiogram (EKG), echocardiogram, coronary angiography

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A large incision is made in the chest to access the heart.
3. Cardiopulmonary Bypass: The heart is stopped, and a heart-lung machine takes over the circulation.
4. Grafting:
   • Venous Grafts: Veins from the leg are harvested and attached to bypass the blocked coronary arteries.
   • Arterial Grafts: Often, the internal mammary artery is detached from the chest wall and grafted.
5. Re-starting the Heart: The heart is started again, and the patient is weaned off the heart-lung machine.
6. Closing the Incision: The chest is closed with sutures or staples.

Tools and Equipment:

• Surgical instruments for cutting and suturing
• Heart-lung machine
• Harvesting tools for veins and arteries

Duration

Generally lasts 3 to 6 hours, depending on complexity and number of grafts.

Setting

Performed in a hospital's cardiac surgery operating room.

Personnel

• Cardiac surgeon
• Surgical nurses
• Anesthesiologist
• Perfusionist (operates the heart-lung machine)
• Surgical assistants

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Irregular heart rhythms

Rare Risks:

• Stroke
• Heart attack during or after surgery
• Kidney failure
• Lung complications

Benefits

• Relief from chest pain
• Improved heart function
• Increased life expectancy
• Enhanced quality of life often within weeks to months

Recovery

• Hospital stay of about 5 to 7 days
• Initial recovery at home, gradually increasing activity level
• Full recovery takes around 6 to 12 weeks
• Follow-up appointments to monitor progress
• Possible cardiac rehabilitation program

Alternatives

Other Treatment Options:

• Medications (beta-blockers, nitrates)
• Percutaneous coronary intervention (PCI), such as angioplasty and stenting

Pros and Cons:

• Medications and PCI may be less invasive but may not be effective for severe multi-vessel disease
• CABG offers longer-term relief but is more invasive

Patient Experience

During the Procedure:

• Patient is under general anesthesia and will not feel pain.

After the Procedure:

• Experience some pain and discomfort, managed with pain medications.
• Feel tired and weak initially, improving over the weeks.
• Discomfort from chest incision and minor leg pain from vein harvest site. Pain management includes medications and activity modification.

Regular activities can typically be resumed in a few months, with ongoing monitoring and lifestyle adjustments for heart health.