33522 Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure)

Name of the Procedure:

Coronary artery bypass grafting (CABG) with venous and arterial grafts; 5 venous grafts. Common names include heart bypass surgery, CABG, and coronary revascularization.

Summary

Coronary artery bypass grafting (CABG) is a surgical procedure that helps improve blood flow to the heart. The surgeon uses blood vessels from other parts of the body, like veins from the leg and arteries from the chest, to bypass blocked or narrowed arteries in the heart. This specific procedure involves using five venous grafts.

Purpose

CABG addresses severe coronary artery disease (CAD), where arteries supplying blood to the heart become narrowed or blocked. The goal is to relieve chest pain (angina), improve heart function, reduce the risk of a heart attack, and increase the patient's quality of life and longevity.

Indications

• Severe chest pain due to CAD
• Multiple blocked arteries
• Failed percutaneous coronary intervention (e.g., stenting)
• Unstable angina
• Left main coronary artery disease
• Patients with heart muscle damage based on diagnostic tests

Preparation

• Fasting for 8-12 hours before surgery.
• Stopping or adjusting certain medications as advised by the doctor.
• Undergoing pre-operative tests such as blood work, chest X-rays, electrocardiograms (ECGs), and coronary angiograms.
• Discussing medical history, allergies, and previous surgeries with the healthcare team.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free during the surgery.
2. Incision: A large incision is made down the center of the chest, and the breastbone is divided to access the heart.
3. Grafting: The surgeon removes veins from the leg (saphenous vein) and prepares them for grafting. Arterial grafts, typically from the chest (internal mammary artery), may also be used.
4. Bypass Machine: The patient is connected to a heart-lung bypass machine that takes over the heart's pumping action and oxygenates the blood.
5. Suturing: The surgeon attaches the grafts to bypass the blocked coronary arteries, ensuring that blood flow is rerouted around the blockages.
6. Completion: The breastbone is wired back together, and the incision is closed with sutures or staples.

Duration

The procedure typically takes 3-6 hours to complete, depending on the complexity and number of grafts required.

Setting

CABG is performed in a hospital's operating room equipped with specialized cardiovascular surgery facilities.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (manages the heart-lung bypass machine)
• Surgical technologists

Risks and Complications

• Common: Infection, bleeding, arrhythmias, and reaction to anesthesia.
• Rare: Stroke, heart attack during or immediately after surgery, kidney failure, or lung complications.
• Management: Close monitoring in the ICU post-surgery, medications, and interventions as necessary.

Benefits

• Relief from chronic chest pain (angina)
• Improved heart function and blood flow
• Reduced risk of heart attack
• Enhanced quality of life and physical activity levels
• Benefits typically realized within weeks to months post-surgery

Recovery

• Hospital stay: 5-7 days, including time in the ICU.
• Post-surgical care: Pain management, wound care, and gradual resumption of physical activity.
• Recovery time: 6-12 weeks to fully recover, with restrictions on heavy lifting and strenuous activity.
• Follow-up: Regular appointments with the cardiologist and surgeon.

Alternatives

• Medications: Managing CAD with drugs to reduce symptoms and risk factors.
• Percutaneous coronary intervention (PCI): Angioplasty with stenting.
• Lifestyle changes: Diet, exercise, quitting smoking, and managing stress.
• Pros and cons: Medications and lifestyle changes are less invasive but may not be sufficient for severe blockages. PCI is less invasive but may not be suitable for all blockages.

Patient Experience

• During: The patient is under general anesthesia and will not feel or remember the procedure.
• After: Post-operative pain managed with medications. Discomfort in the chest and incision site is common but manageable.
• Pain management: Pain relievers and comfort measures are provided to ease discomfort.