Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation
Summary
A reoperation for coronary artery bypass (CABG) or valve procedure is a surgical intervention performed more than one month after the initial heart surgery. This procedure aims to address issues such as recurring symptoms, graft failure, or complications from the initial surgery.
Purpose
The procedure addresses conditions like recurring chest pain, graft occlusion, or valve dysfunction that may arise after the initial heart surgery. The goals are to restore proper blood flow, improve heart function, and alleviate symptoms.
Indications
- Recurring chest pain (angina)
- Graft occlusion or failure
- Valve dysfunction or leakage
- Persistent or new symptoms despite initial surgery
- Evidence of compromised blood flow from diagnostic tests
Preparation
- Fasting for at least 8 hours before the procedure
- Stopping certain medications (e.g., blood thinners) as advised
- Undergoing diagnostic tests like EKG, echocardiogram, and chest X-ray
- Blood work to assess overall health and readiness for surgery
Procedure Description
- The patient is given general anesthesia to ensure they are asleep and pain-free.
- An incision is made in the chest to access the heart.
- The heart is connected to a heart-lung machine to take over its functions during surgery.
- The surgeon identifies and corrects issues such as replacing failed grafts or repairing/replacing a heart valve.
- The heart is checked for proper function before disconnecting from the heart-lung machine.
- The chest incision is closed with sutures or staples.
Tools and Equipment: Surgical instruments, heart-lung machine, replacement grafts or valve prostheses.
Anesthesia: General anesthesia is used.
Duration
Typically, the procedure takes about 4 to 6 hours to complete.
Setting
The procedure is performed in a hospital operating room equipped with cardiovascular surgical facilities.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
- Surgical assistants
Risks and Complications
Common risks include:
- Infection
- Bleeding
- Blood clots
- Heart attack
Rare but serious complications may involve:
- Stroke
- Kidney failure
- Respiratory complications
Management includes close monitoring and prompt intervention by the medical team.
Benefits
Expected benefits include improved blood flow and heart function, relief from symptoms, and enhanced quality of life. Benefits are often noticed within weeks to months post-operation.
Recovery
- Intensive care monitoring for the first 24-48 hours
- Gradual transition to a regular hospital room for 5-7 days
- Pain management with prescribed medications
- Instructions on wound care and activity restrictions
- Follow-up appointments to monitor recovery
- Full recovery may take several weeks to months, with gradual resumption of normal activities
Alternatives
- Medical management with medications
- Percutaneous coronary intervention (PCI) for certain cases
- Less invasive valve repair procedures
Pros and Cons: Alternatives may offer less recovery time but might not be as effective for severe cases compared to reoperation.
Patient Experience
Patients will be under general anesthesia and will not feel the procedure. Postoperatively, they may experience discomfort, pain, and fatigue, managed with medications and supportive care. Full recovery involves gradual improvement in physical activity and daily functions.