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Coronary Artery Disease: Should I Have Bypass Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Coronary Artery Disease: Should I Have Bypass Surgery?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your |
Get the facts
Your options
- Have coronary artery bypass surgery along with medical therapy (a heart-healthy lifestyle and medicines).
- Don't have coronary artery bypass surgery. No matter what you choose, you still take medicines and have a heart-healthy lifestyle.
This decision is for people who have stable angina and whose doctor has said bypass surgery may be an option for them. Stable angina means that you can usually predict when your symptoms will happen. You probably know what things cause your angina. For example, you know how much activity usually causes your angina.
Key points to remember
- Bypass surgery can relieve angina symptoms such as chest pain or pressure. Most people who have bypass surgery get relief from angina.
- Bypass surgery might improve the chance of living a longer life for certain people. Whether surgery might do this for you depends on several things, including which arteries are narrowed, how many are narrowed, and whether you have other health problems such as diabetes.
- Most of the time, bypass surgery is open-chest surgery. Its risks include heart attack, stroke, and death. Recovery usually takes at least 2 months.
- Whether you have surgery or not, having a heart-healthy lifestyle and taking medicine give you the best chance of living a longer, healthier life.
- 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 help you live longer. The long-term benefits of surgery may or may not outweigh the short-term risks for you.
FAQsWhat is coronary artery 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, Opens dialog.
In most cases, bypass surgery, Opens dialog 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, Opens dialog. 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.
What are your options if you don't have surgery?
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, Opens dialog, 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.
How do you know if bypass surgery might help you?
You may have several tests to see if a bypass could help you. You may have had an angiogram, Opens dialog 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, Opens dialog 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.
What are the benefits of bypass surgery?
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
What are the risks of bypass surgery?
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, Opens dialog.
- 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.
What do numbers tell us about benefits and risks of bypass surgery?
Benefits
Angina relief: In studies, about 84 out of 100 people, Opens dialog 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, Opens dialog)
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, Opens dialog.
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, Opens dialog. 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
What is coronary artery 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, Opens dialog.
In most cases, bypass surgery, Opens dialog 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, Opens dialog. 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.
What are your options if you don't have surgery?
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, Opens dialog, 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.
How do you know if bypass surgery might help you?
You may have several tests to see if a bypass could help you. You may have had an angiogram, Opens dialog 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, Opens dialog 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.
What are the benefits of bypass surgery?
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
What are the risks of bypass surgery?
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, Opens dialog.
- 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.
What do numbers tell us about benefits and risks of bypass surgery?
Benefits
Angina relief: In studies, about 84 out of 100 people, Opens dialog 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, Opens dialog)
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, Opens dialog.
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, Opens dialog. 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
Compare your options
| Have coronary artery bypass surgery | Don't have bypass surgery | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Compare
What is usually involved? | ||
|---|---|---|
What are the benefits? | ||
What are the risks and side effects? |
- After surgery, you will stay in the hospital for a few days.
- You may have some pain and soreness from the chest incision for a few weeks. Recovery usually takes at least 2 months.
- You will take medicines and have a heart-healthy lifestyle (medical therapy).
- Bypass surgery can relieve angina symptoms.
- Surgery may help certain people live longer. Whether it might help you depends on a few things, including which arteries need to be bypassed and whether you have diabetes.
- Bypass surgery has short-term risks that include heart attack, stroke, kidney problems, and death. Your risk depends, in part, on your medical problems.
- Other risks from surgery include problems from anesthesia and an infection in the chest incision.
- You have angioplasty and take medicines and have a heart-healthy lifestyle.
- Or you take medicines and have a heart-healthy lifestyle.
- You may have angioplasty or bypass surgery later.
- You avoid the risks of bypass surgery.
- Angioplasty with medical therapy, or medical therapy alone, can relieve angina.
- Medical therapy can help you live longer and lower your risk of a heart attack and stroke.
- You may still have angina.
Personal stories about coronary artery bypass surgery
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My doctor tells me that some of my heart arteries are too narrow. And that's causing my chest pain. She thinks surgery is an option for me, so we talked about it. I want to feel better and avoid a heart attack, but I can do this without having surgery. I worry about having a stroke because of the surgery. So I've decided to keep taking medicines, exercising, and eating a heart-healthy diet.
Saul, age 85
A couple of people in my family have heart disease. I never thought I'd have it too. But then I started having some pressure in my chest. I had some tests, and my doctor says I have severe heart disease. Bypass surgery could be an option for me. But my symptoms don't bother me a lot. And I just started taking my new heart medicines. My doctor said I could wait to decide about surgery.
Juanita, age 56
I never thought twice about whether bypass surgery was right for me. After my heart attack, I wanted to do everything I could to get healthier. I started exercising and eating better and taking medicines. But it didn't help my chest pain, and I couldn't do all the things I wanted to do. I knew it was time to have the surgery.
Alan, age 70
When my doctor and I talked about bypass surgery, I asked a lot of questions. I'm afraid of the risks and the long recovery. But I understand why surgery might be a good choice for me. It's because of which arteries need to be operated on. So I think I'm willing to accept the risks of the surgery. I want to be around for my husband and kids.
Gloria, age 67
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Each pair of questions uses a 3 point scale where 3 is more important, 1 is less important and 0 is equally important. Use the right and left arrow keys to navigate the scale.Reasons to have bypass surgery
Reasons not to have bypass surgery
I am willing to accept the risks of surgery.
I'm worried about the risks of surgery.
I want more relief from my angina.
I can accept having a little angina as long as I can still do my daily activities.
I'm willing to have a surgery that has a long recovery.
I don't want to have a surgery that has a long recovery.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Use the following 3 point scale where 3 is leaning toward, 1 is may be leaning toward, and 0 is undecided. Use the right and left arrow keys to navigate the scale.Having coronary artery bypass surgery
NOT having coronary artery bypass surgery.
What else do you need to make your decision?
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
Credits
| Author | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
References
Citations
- Alkhouli M, et al. (2021). Trends in characteristics and outcomes of hospital inpatients undergoing coronary revascularization in the United States, 2003-2016. JAMA Network Open, 3(2): e1921326. DOI: 10.1001/jamanetworkopen.2019.21326. Accessed April 6, 2021.
- Bravata DM, et al. (2007). Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine, 147(10): 703–716.
- Fernandez FG, et al. (2019). The Society of Thoracic Surgeons national database 2019 annual report. Annals of Thoracic Surgery, 108(6): 1625–1632. DOI: 10.1016/j.athoracsur.2019.09.034. Accessed April 6, 2021.
- Gaudino M, et al. (2020). Considerations for reduction of risk of perioperative stroke in adult patients undergoing cardiac and thoracic aortic operations: A scientific statement from the American Heart Association. Circulation, 142(14): e193-e209. DOI: 10.1161/CIR.0000000000000885. Accessed August 27, 2020.
- Lawton JS, et al. (2022). 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: A report from the American College of Cardiology/American Heart Association. Journal of the American College of Cardiology, 79(2): e21–e129. DOI: 10.1016/j.jacc.2021.09.006. Accessed December 9, 2021.
Coronary Artery Disease: Should I Have Bypass Surgery?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Have coronary artery bypass surgery along with medical therapy (a heart-healthy lifestyle and medicines).
- Don't have coronary artery bypass surgery. No matter what you choose, you still take medicines and have a heart-healthy lifestyle.
This decision is for people who have stable angina and whose doctor has said bypass surgery may be an option for them. Stable angina means that you can usually predict when your symptoms will happen. You probably know what things cause your angina. For example, you know how much activity usually causes your angina.
Key points to remember
- Bypass surgery can relieve angina symptoms such as chest pain or pressure. Most people who have bypass surgery get relief from angina.
- Bypass surgery might improve the chance of living a longer life for certain people. Whether surgery might do this for you depends on several things, including which arteries are narrowed, how many are narrowed, and whether you have other health problems such as diabetes.
- Most of the time, bypass surgery is open-chest surgery. Its risks include heart attack, stroke, and death. Recovery usually takes at least 2 months.
- Whether you have surgery or not, having a heart-healthy lifestyle and taking medicine give you the best chance of living a longer, healthier life.
- 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 help you live longer. The long-term benefits of surgery may or may not outweigh the short-term risks for you.
What is coronary artery 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, Opens dialog.
In most cases, bypass surgery, Opens dialog 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, Opens dialog. 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.
What are your options if you don't have surgery?
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, Opens dialog, 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.
How do you know if bypass surgery might help you?
You may have several tests to see if a bypass could help you. You may have had an angiogram, Opens dialog 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:5
- Your left main, Opens dialog 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.
What are the benefits of bypass surgery?
What are the risks of bypass surgery?
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, Opens dialog.
- 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.
What do numbers tell us about benefits and risks of bypass surgery?
Benefits
Angina relief: In studies, about 84 out of 100 people, Opens dialog 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.)2
*Based on the best available evidence (evidence quality: moderate, Opens dialog)
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, Opens dialog.
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, Opens dialog. 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.3 Some risk factors can increase your risk for stroke. These include older age, diabetes, and high blood pressure.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.3
- Kidney problems: About 2 out of 100 people have kidney problems. So about 98 people out of 100 don't have kidney problems.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.1, 3
2. Compare your options
| Have coronary artery bypass surgery | Don't have bypass surgery | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Personal stories about coronary artery bypass surgery
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I never thought twice about whether bypass surgery was right for me. After my heart attack, I wanted to do everything I could to get healthier. I started exercising and eating better and taking medicines. But it didn't help my chest pain, and I couldn't do all the things I wanted to do. I knew it was time to have the surgery."
— Alan, age 70
"My doctor tells me that some of my heart arteries are too narrow. And that's causing my chest pain. She thinks surgery is an option for me, so we talked about it. I want to feel better and avoid a heart attack, but I can do this without having surgery. I worry about having a stroke because of the surgery. So I've decided to keep taking medicines, exercising, and eating a heart-healthy diet."
— Saul, age 85
"When my doctor and I talked about bypass surgery, I asked a lot of questions. I'm afraid of the risks and the long recovery. But I understand why surgery might be a good choice for me. It's because of which arteries need to be operated on. So I think I'm willing to accept the risks of the surgery. I want to be around for my husband and kids."
— Gloria, age 67
"A couple of people in my family have heart disease. I never thought I'd have it too. But then I started having some pressure in my chest. I had some tests, and my doctor says I have severe heart disease. Bypass surgery could be an option for me. But my symptoms don't bother me a lot. And I just started taking my new heart medicines. My doctor said I could wait to decide about surgery."
— Juanita, age 56
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have bypass surgery
Reasons not to have bypass surgery
I am willing to accept the risks of surgery.
I'm worried about the risks of surgery.
I want more relief from my angina.
I can accept having a little angina as long as I can still do my daily activities.
I'm willing to have a surgery that has a long recovery.
I don't want to have a surgery that has a long recovery.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having coronary artery bypass surgery
NOT having coronary artery bypass surgery.
5. What else do you need to make your decision?
Check the facts
1. Is bypass surgery the only way to relieve your angina symptoms?
- Yes
- No
- I'm not sure
2. Will bypass surgery cure your heart disease?
- Yes
- No
- I'm not sure
3. Can bypass surgery help certain people live longer?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
- Alkhouli M, et al. (2021). Trends in characteristics and outcomes of hospital inpatients undergoing coronary revascularization in the United States, 2003-2016. JAMA Network Open, 3(2): e1921326. DOI: 10.1001/jamanetworkopen.2019.21326. Accessed April 6, 2021.
- Bravata DM, et al. (2007). Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine, 147(10): 703–716.
- Fernandez FG, et al. (2019). The Society of Thoracic Surgeons national database 2019 annual report. Annals of Thoracic Surgery, 108(6): 1625–1632. DOI: 10.1016/j.athoracsur.2019.09.034. Accessed April 6, 2021.
- Gaudino M, et al. (2020). Considerations for reduction of risk of perioperative stroke in adult patients undergoing cardiac and thoracic aortic operations: A scientific statement from the American Heart Association. Circulation, 142(14): e193-e209. DOI: 10.1161/CIR.0000000000000885. Accessed August 27, 2020.
- Lawton JS, et al. (2022). 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: A report from the American College of Cardiology/American Heart Association. Journal of the American College of Cardiology, 79(2): e21–e129. DOI: 10.1016/j.jacc.2021.09.006. Accessed December 9, 2021.
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Current as of: October 2, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
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