Coronary Artery Disease: Should I Have Bypass Surgery?

Bypass surgery—also called coronary artery bypass graft surgery—helps improve blood flow to the heart muscle in people with severe coronary artery disease.

In most cases, bypass surgery is open-chest surgery. The surgeon connects, or grafts, a healthy blood vessel from another part of your body to the narrowed coronary artery. The grafted blood vessel goes around (bypasses) the narrowed part of the artery. This makes a new path for blood to your heart muscle.

Some people have bypasses in two or more arteries. How many you need depends on how many arteries, and which ones, are narrowed.

Bypass surgery is not a cure for heart disease. The surgery doesn't change the way arteries harden or narrow because of heart disease. And it may not bypass all the diseased areas that you may have in your arteries.

Even after surgery, you can still get new places in your arteries that are narrowed. This can happen in the new blood vessels used in the bypass, as well as in the other arteries. If this happens, you may choose to have another surgery or angioplasty with stents. That's why after surgery you will still take medicines and have a heart-healthy lifestyle to give you the best chance of living a longer, healthier life.

Recovery after surgery

You will stay in the hospital for a few days after the surgery. You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. These symptoms usually get better after 4 to 6 weeks. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you'll avoid lifting heavy objects or doing activities that strain your chest or upper arm muscles.

Heart-healthy lifestyle and medicines

You can do things after surgery to help yourself stay healthy and prevent problems. Medicines and a healthy lifestyle—known as medical therapy—can help your bypass grafts last and stay open longer. Medical therapy also can lower your risk of a heart attack or stroke.

You will likely take medicines to prevent blood clots, lower cholesterol, and manage blood pressure. A heart-healthy lifestyle includes eating healthy food, being active, staying at a healthy weight, managing other health problems, and not smoking. A cardiac rehab program can help you have a heart-healthy lifestyle.

Surgery isn't right for everyone. Some people can be helped by angioplasty along with medicines and a heart-healthy lifestyle (medical therapy). Others use medical therapy alone. Both of these treatments can help relieve symptoms of stable angina. Medicines and a heart-healthy lifestyle can help you live longer and lower your risk of a heart attack and stroke.

• Angioplasty with stents, along with medicines and a heart-healthy lifestyle. Angioplasty is done through a blood vessel, so it is less invasive than surgery. The procedure has fewer risks for some people. Recovery is quicker than with surgery. Over time, there is a chance that blood vessels with stents can close. There also is a chance that you'll need to decide whether or not to have another angioplasty or a bypass surgery.
• Medical therapy alone. You will take medicines and have a heart-healthy lifestyle with any treatment that you choose. Medical therapy alone may be a choice for you if your angina is not affecting your quality of life. The medicines help you feel better, prevent blood clots, lower cholesterol, and manage blood pressure. A heart-healthy lifestyle includes eating healthy foods, being physically active, staying at a healthy weight, and not smoking.

One of these treatments may be an option for you. It depends on your age, your other health problems, and how severe your heart disease is. It also depends on what you want. You and your doctor can decide together whether bypass surgery or another treatment is right for you.

You may have several tests to see if a bypass could help you. You may have had an angiogram that showed your doctor the location and amount of narrowing in your arteries. Your doctor also may have checked how well your heart is pumping blood.

Whether a bypass is an option for you depends on several things. These include which coronary arteries are narrowed, your age, and other health problems that you may have. It also depends on how much your angina keeps you from doing your daily activities and enjoying your life.

Surgery may be an option for many reasons. These reasons include the following:^{footnote 5}

• Your left main heart artery is very narrow.
• Multiple arteries of the heart are narrowed.
• You have diabetes, and two or more of the larger arteries are narrowed.
• The benefits of surgery for you are greater than the risks.

As you decide about surgery, think about what is most important to you. Talk to your doctor about what you hope surgery could do to improve your symptoms or lengthen your life. The benefits of surgery may or may not outweigh the risks for you.

Bypass surgery can:

• Relieve angina symptoms and improve quality of life. You may be able to do more of your daily activities.^{footnote 2}
• Help certain people live longer. Whether it might help you live longer depends on several things. These include your overall health and which arteries need to be bypassed.^{footnote 5}

The chances of having a serious problem with bypass surgery increase with age. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. Your doctor can help you understand what your risk for problems is.

The risks during or soon after bypass surgery include:

• Infection.
• Kidney problems.
• Atrial fibrillation.
• Heart attack.
• Stroke.
• Short-term problems with thinking and memory. This is more common in older people. It tends to get better within several months of surgery.
• Death.

Benefits

Angina relief: In studies, about 84 out of 100 people who had bypass surgery had angina relief after 1 year. This relief lasted at least 5 years.* (Some of these people had another procedure that could have added to their angina relief.)^{footnote 2}

*Based on the best available evidence (evidence quality: moderate)

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence. The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Risks

Take 100 people who have bypass surgery. Complication rates in hospitals show people face these risks from bypass surgery:

• Stroke: About 1 out of 100 people have a stroke during or soon after surgery. That means that about 99 people out of 100 don't have a stroke.^{footnote 3} Some risk factors can increase your risk for stroke. These include older age, diabetes, and high blood pressure.^{footnote 4} Talk to your doctor about your own risk.
• Deep infection of the incision: Less than 1 out of 100 people have a deep infection in the chest incision. This means that more than 99 out of 100 don't have this problem.^{footnote 3}
• Kidney problems: About 2 out of 100 people have kidney problems. So about 98 people out of 100 don't have kidney problems.^{footnote 3}
• Death: About 1 to 2 out of 100 people die during or soon after surgery. About 98 to 99 people out of 100 survive the surgery.^{footnote 1, footnote 3}