Informed Consent for Coronary Artery Bypass Grafting (CABG) Surgery

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Informed Consent for Coronary Artery Bypass Grafting (CABG) Surgery

Patient and Surgical Team Information

Nature and Purpose of the Procedure

Coronary Artery Bypass Grafting is an open-heart surgical procedure performed to treat severe coronary artery disease. The surgery restores blood flow to ischemic areas of the heart muscle by bypassing blocked or narrowed sections of the coronary arteries. The surgeon harvests healthy blood vessels from other parts of the body (typically the left internal mammary artery from the chest wall, the saphenous vein from the leg, or the radial artery from the arm) to use as grafts. Under general anesthesia, a median sternotomy (incision through the breastbone) is performed to access the heart. In standard CABG, the heart is stopped, and blood circulation is maintained by a cardiopulmonary bypass machine (heart-lung machine). The surgeon then grafts the harvested vessels beyond the blockages. Once the grafts are secure, the heart is restarted, the bypass machine is disconnected, chest tubes are placed to drain fluid, and the sternum is closed with surgical wire. The procedure typically takes 3 to 6 hours.

Material Risks and Potential Complications

Bleeding during or after surgery, which may require blood product transfusions or an emergency return to the operating room for surgical re-exploration.
Arrhythmias, particularly atrial fibrillation (AFib), occurring in approximately 30 percent of patients, which may require medication or temporary pacing.
Infections of the chest wound (mediastinitis) or graft harvest sites, which can range from superficial skin infections to deep sternal wound infections requiring IV antibiotics or surgical debridement.
Stroke or transient ischemic attack (TIA), which may cause permanent neurological deficit, occurring in 1 to 2 percent of cases due to plaque displacement or micro-emboli.
Myocardial infarction (heart attack) during or immediately after the procedure due to graft occlusion, vascular spasm, or incomplete revascularization.
Acute kidney injury (AKI) or renal failure related to cardiopulmonary bypass perfusion, which may transiently or permanently require dialysis.
Neurocognitive decline or post-operative cognitive dysfunction, sometimes called pump head syndrome, causing temporary memory issues or confusion.
Sternum nonunion or instability, requiring surgical wire revision.
Death: overall elective procedural mortality is approximately 1 to 2 percent, depending on baseline cardiac function, age, and comorbidities.

Reasonable Alternatives to CABG

Percutaneous Coronary Intervention (PCI) with stent placement. While less invasive, clinical studies show CABG is superior for long-term survival in patients with multi-vessel disease or diabetes.
Optimal medical management using antianginal drugs, statins, blood pressure medications, and intensive lifestyle changes.
No intervention. Decline surgery and accept the risk of worsening angina, progressive heart failure, and sudden cardiac death.

Expected Benefits

The primary expected benefits of CABG include significant relief from chest pain (angina), improved functional capacity, and reduction in cardiac medication dependence. In patients with multi-vessel disease, left main coronary stenosis, or impaired left ventricular function, CABG has been clinically proven to improve long-term survival rates and reduce the risk of future fatal heart attacks.

Postoperative Expectations and Recovery

Recovery from open-heart surgery requires an initial intensive care unit (ICU) stay of 1 to 2 days, followed by 4 to 5 days on a telemetry floor. Full recovery takes approximately 6 to 12 weeks. Sternal precautions must be strictly maintained for 8 weeks: no lifting objects over 10 pounds, no pushing or pulling with the arms, and avoiding driving to allow the bone to heal. Participation in a structured outpatient cardiac rehabilitation program is highly recommended.

Questions and Understanding Confirmation

I confirm that I have had the opportunity to read this consent form carefully and ask questions of my surgical team. All my questions have been answered to my satisfaction in language I understand. I believe I am making an informed and voluntary decision.

Signatures and Verification

Patient / Legally Authorized Representative Signature
Consenting Cardiothoracic Surgeon Signature
Witness Signature
Date and Time of Consent
Document ID: CC-PENDING
CONSENTCOLLECT