| ICD-9-CM: |
| 36.1 - | Coronary Bypass Anastomosis for Heart Revascularization |
| 36.10 - | Aortocoronary Bypass for Heart Revascularization NOS, Direct Revascularization: Cardiac with Catheter Stent, Prothesis, or Vein Graft, Coronary with Catheter Stent, Prothesis, or Vein Graft, Heart Muscle with Catheter Stent, Prothesis, or Vein Graft, Myocardial with Catheter Stent, Prothesis, or Vein Graft, Heart Revascularization NOS |
| 36.11 - | Aortocoronary Bypass of One Coronary Artery |
| 36.12 - | Aortocoronary Bypass of Two Coronary Arteries |
| 36.13 - | Aortocoronary Bypass of Three Coronary Arteries |
| 36.14 - | Aortocoronary Bypass of Four or More Coronary Arteries |
| 36.15 - | Single Internal Mammary-coronary Artery Bypass; Anastomosis (Single): Mammary Artery to Coronary Artery, Thoracic Artery to Coronary Artery |
| 36.16 - | Double Internal Mammary-coronary Artery Bypass; Anastomosis, Double: Mammary Artery to Coronary Artery, Thoracic Artery to Coronary Artery |
| 36.17 - | Abdominal-coronary Artery Bypass; Anastomosis: Gastroepiploic-coronary Artery |
| 36.19 - | Bypass Anastomosis for Heart Revascularization, Other |
| | | |  | | © Reed Group | | |
Coronary bypass surgery refers to several procedures that graft new channels (bypass conduits) into the heart to reroute blood flow (revascularize) around a section of coronary artery blocked by hardened, fatty deposits (plaque). Coronary artery bypass grafting (CABG) is one of the most frequently performed surgeries in the US, and is most often performed as an open surgical procedure (open heart surgery). This major surgery involves arresting heart muscle action and grafting a new bypass conduit in place while maintaining circulation and lung function via a heart-lung machine or “pump.” However, the trend is toward less invasive techniques with smaller incisions instead of the traditional open procedure, including port access CABG, total endoscopic robotically-assisted CABG (TECAB), off-pump CABG (OPCAB) and a minimally invasive direct coronary artery bypass (MIDCAB), which is used primarily when a single artery is obstructed. In all of these procedures, grafts for the bypass conduit use veins taken from the legs (greater and lesser saphenous veins), an artery taken from the inside of the chest wall (internal mammary artery or IMA), or more recently, multiple arterial grafts using thoracic arteries. Thoracic arteries have been shown to stay open longer than veins, reducing the risk of repeat bypass surgeries.
The advantages of minimally invasive coronary bypass procedures include less post-operative discomfort, reduced risk of wound infection, and a shorter recovery period. Avoiding the need to perform cardiopulmonary bypass (CPB) with the heart-lung machine reduces risk of bleeding and clot formation (embolism), reduces postoperative inflammatory response, and reduces the possibility of postoperative conditions such as kidney failure, stroke, or nervous system deficit, especially in elderly patients or individuals severely compromised by coronary artery disease (CAD).
Coronary bypass surgery generally is the treatment of choice for severe coronary artery disease (CAD) that affects more than 2 vessels in the heart, left main and bifurcation lesions, and is the method of choice in patients with diabetes. Less severe disease affecting one vessel usually is treated either by percutaneous coronary intervention (PCI) with the placement of cardiac stents or by less invasive percutaneous coronary transluminal angioplasty (PCTA), which breaks up the atherosclerotic plaques in the artery.
|
Source: Medical Disability Advisor
| Coronary bypass surgery is performed to revascularize the heart in individuals with coronary artery disease (CAD), also called coronary atherosclerosis, whose coronary arteries are narrowed by the formation of plaque. Coronary bypass surgery relieves chest discomfort (angina pectoris) that occurs with activity (effort angina) in individuals with CAD and prolongs life when CAD is pervasive and irreversible.
Plaque (atheroma) is an accumulation of white blood cells, cell debris, fatty substances (cholesterol and fatty acids), calcium, and fibrous tissue that forms on artery walls. Formation of plaque narrows the arteries and limits the flow of blood, oxygen, and nutrients needed for proper functioning of the heart muscle (myocardium). Without a constant supply of blood, nutrients, and oxygen (ischemia), cells in the heart tissue begin to die and heart attack (myocardial infarction) can result. Angina pectoris occurs when oxygen demand by the heart muscle (myocardial oxygen demand) is greater than is supplied by blood flow. CABG surgery restores blood flow and the critical delivery of oxygen. |
Source: Medical Disability Advisor
| Performance of the open heart procedure is major surgery that requires opening the chest with a long incision in the chest wall (median sternotomy). Because heart activity must be arrested to allow the surgeon to work on the heart, the patient's blood is routed through a heart-lung machine that performs the normal work of the heart during the surgery (cardiopulmonary bypass or CPB). The individual's blood is supplemented by the blood of multiple compatible donors and blood expanders to ensure that an adequate volume of oxygen-carrying red blood cells continues to circulate within the body. The heart-lung machine oxygenates the blood and continuously pumps it back into the individual's body while the heart is not beating. The motionless state of the heart allows this sometimes lengthy surgery (3 to 7 hours) to be done under conditions conducive to the best technical result. During the surgery, the surgeon will attach the graft (saphenous vein, mammary artery or synthetic conduit) to the aorta, the main artery going into the heart, and attach the other end to the coronary artery on the other side of the blockage or blockages. After these bypasses are performed, the individual is weaned from the heart-lung machine over a period of hours. Sometimes a device known as an intra-aortic balloon pump is used to help with weaning. The balloon pump is then gradually discontinued over one to several days.
The four less invasive surgical methods use smaller incisions and do not always require CPB with the heart-lung machine. Port access CABG requires only limited incisions and uses chemical substrates and/or hypothermia to arrest heart activity (cardioplegic arrest). It is noted for less postoperative discomfort and faster recovery than the open procedure. Total endoscopic robotically assisted CABG is performed similarly with cardioplegic arrest of heart activity and small incisions; the surgeon views the heart and controls robotic placement of bypass conduits through a flexible, lighted fiber-optic instrument (endoscope). Off-pump CABG (OPCAB) requires opening the chest with sternotomy or several smaller incisions and is performed on the beating heart with mechanical suction stabilization without using the heart-lung machine. An incision in the left chest (left anterior thoracotomy) allows minimally invasive direct coronary artery bypass (MIDCAB) to be performed, also without use of the heart-lung machine.
If venous grafts are being used, a saphenous vein (usually the greater saphenous vein but sometimes the lesser is used as well) is removed from one or both legs and used to bypass narrowed areas of the coronary arteries identified preoperatively by a coronary angiogram. One and sometimes both internal mammary arteries (which have a larger diameter than veins) may be used in addition to the saphenous veins. Use of both internal mammary arteries is reserved for younger patients or those whose saphenous veins are unsuitable for the procedure. Venous grafts are not always favored because of a high rate of failure shown in long-term experience. Thoracic artery grafts are being used more often for their tendency to stay open longer after placement. The selection and type of preparation of bypass conduits varies depending on surgeon preference. |
Source: Medical Disability Advisor
| Relief of angina pectoris and increased life expectancy is achieved in most individuals undergoing CABG surgery. However, recurrence of coronary artery blockage and angina is common in individuals with pervasive CAD due to partial narrowing or complete occlusion of the vein bypass. About half of individuals undergoing this surgery eventually die of late atherosclerosis and occlusion at the grafting site (Anderson). Vein bypass occlusion occurs more often in older individuals, diabetics, overweight or obese individuals, and those who continue to smoke and/or who continue to consume a high-fat, high-glycemic diet. Results of bypass surgery with thoracic artery grafts are promising and are being shown to reduce repeat surgeries. Surgeons report that newer, less invasive surgical techniques and use of arterial grafts rather than venous grafts will eventually result in fewer people needing repeat surgeries. |
Source: Medical Disability Advisor
| Major complications of coronary bypass surgery include stroke (which carries a 10% to 21% chance of death) and chest infection (1% to 4%) (Anderson). Other possible complications include bleeding, kidney failure (depending on preoperative kidney function), and heart attack during or after surgery. Risk for complications is a case-by-case consideration depending on age, general health, smoking history, underlying chronic disease, and pre- and postoperative heart function. |
Source: Medical Disability Advisor
| After the recovery period many individuals can return to the job they performed before surgery. Although energy levels generally increase after recovery, physical activity may be limited for a period or indefinitely in individuals with pervasive CAD whose symptoms recur. |
Source: Medical Disability Advisor
| Anderson, R. W., and C. A. Milano. "Acquired Heart Disease: Coronary Insufficiency." Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Eds. D. C. Sabiston and C. M. Townsend. 16th ed. Philadelphia: W.B. Saunders, 2001. 1267-1285. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|