33534 Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts

Name of the Procedure:

Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts
Common name(s): CABG, Coronary Bypass Surgery, Heart Bypass Surgery

Summary

Coronary artery bypass graft (CABG) surgery involves taking arteries from other parts of the body to create new paths for blood to flow to the heart, bypassing blocked or narrowed coronary arteries. In this procedure, two arterial grafts are used to circumvent the obstructions and restore adequate blood supply to the heart muscle.

Purpose

CABG is performed to address severe coronary artery disease that can lead to chest pain (angina), shortness of breath, heart attacks, and other heart-related conditions. The main goal is to improve blood flow to the heart, alleviate symptoms, enhance quality of life, and reduce the risk of heart attacks.

Indications

1. Severe chest pain due to multiple narrowed coronary arteries.
2. Left main coronary artery disease.
3. Multiple high-risk coronary artery blockages.
4. Ineffectiveness of other treatments like medication or angioplasty.
5. Diminished function of the left ventricle.

Preparation

1. Patients may need to fast for several hours before the procedure.
2. Blood tests, chest X-rays, ECGs, and coronary angiography are typically required.
3. Stop certain medications as advised by your doctor.
4. Quit smoking and manage chronic conditions like diabetes or hypertension.
5. Hospital admission the day before the surgery might be required.

Procedure Description

1. The patient is administered general anesthesia to ensure they are asleep and pain-free.
2. A median sternotomy incision is made down the chest to access the heart.
3. The heart may be stopped temporarily, and a heart-lung machine takes over circulation.
4. The surgeon harvests two arterial grafts (typically from the internal thoracic artery or radial artery).
5. These grafts are attached to the coronary arteries past the blockages, creating a new pathway.
6. The heart is restarted, and the patient is disconnected from the heart-lung machine.
7. The chest incision is closed with sutures or staples.

Duration

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

Setting

Performed in a hospital operating room equipped with specialized surgical tools and heart-lung machine.

Personnel

1. Cardiothoracic surgeon
2. Surgical assistants
3. Anesthesiologist
4. Perfusionist (operates the heart-lung machine)
5. Operating room nurses

Risks and Complications

1. Bleeding
2. Infection
3. Heart attack or stroke
4. Irregular heart rhythms
5. Graft failure
6. Complications related to anesthesia
7. Kidney failure (rarely)

Benefits

1. Improved blood flow to the heart.
2. Reduced chest pain and heart attack risk.
3. Better quality of life and physical capabilities.
4. Increased life expectancy for many patients.

Recovery

1. Initial recovery in Intensive Care Unit (ICU) for monitoring.
2. Hospital stay of 5-7 days post-surgery.
3. Follow-up visits and cardiac rehabilitation for weeks to months.
4. Avoid strenuous activities for about 6-8 weeks.
5. Adherence to heart-healthy lifestyle changes and prescribed medications.

Alternatives

1. Percutaneous Coronary Intervention (PCI, or angioplasty with stenting).
2. Medication management.
3. Lifestyle modifications.
4. Pros and cons depend on the patient's specific conditions, with CABG being more definitive for certain severe cases.

Patient Experience

Patients might experience some discomfort and pain at the incision sites and feel tired post-surgery. Adequate pain management will be provided. The feeling of significant improvement in symptoms like chest pain and breathlessness can be expected over time, gradually leading to enhanced physical activity and overall wellness.