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The procedure is a CABG x3 (33533; 33518), PV isolation with RF clamp ablation (33257), and LAA ligation.

The patient is a 74-year-old female who presents with atrial fibrillation and severe CAD on angio.

"PROCEDURE: Patient was systemically heparinized. Right and left pulmonary vein isolation was performed with atrcure system clamp ablation. Pt had bradycardia to 50 and conversion to NSR during right side PV isolation. LIMA was carefully anastomosed to the proximal LAD with 7-0 prolene. De-airing was performed. Sidebiting clamp was placed on the proximal ascending aorta and the proximal SVG was carefully anastomosed to the ascending aorta us 6-0 prolene in standard running technique. Ascending aorta and SVG were carefully de-aired and the sidebiting clamp was released. Heart was then lifted and the SVG was carefully anastomosed side-to-side to the D1, followed by end to side to the D2 using 7-0 prolene sutures. Careful deairing was performed and SPY angio imaging was used to visualize all grafts. Hemostasis was confirmed."