Heart 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.
Don't have coronary artery bypass surgery. You can try angioplasty or medical therapy instead.

Key points to remember

Bypass surgery can relieve chest pain (angina) and other symptoms. Most people who have bypass surgery get relief from chest pain right away.
Bypass surgery can improve your chances of living a longer life. It may also lower your risk of heart attack.
Most of the time, bypass surgery is open-chest surgery. It carries the rare risk of heart attack, stroke, and even death.
Bypass surgery can't cure coronary artery disease. You will still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life. And you will probably need to take medicines.
If only two of your arteries are blocked and neither of these is the left main artery, your choice may not be clear. Talk with your doctor about the best treatment for you. This may depend on your age, your health, and how much your chest pain is affecting your quality of life.
Bypass surgery is just one treatment for coronary artery disease. Others include angioplasty with stents, medicines, and lifestyle changes. Ask your doctor what you can expect to happen if you have bypass surgery compared with using these other treatments.

FAQs

What is coronary artery bypass surgery?

Coronary artery bypass graft surgery (also called CABG or "cabbage") helps improve blood flow to the heart in people with severe coronary artery disease. The surgeon connects, or grafts, a healthy artery or vein from another part of your body to the blocked coronary artery. The grafted blood vessel goes around (bypasses) the blocked part of the artery. This provides a new pathway for blood to your heart.

The goals of bypass surgery are to:

Relieve chest pain (angina) and other symptoms of coronary artery disease.
Improve your quality of life.
Increase your heart’s ability to pump blood.
Improve your chances of living a longer life.
Reduce your chances of having a heart attack.

Bypass surgery does a good job of treating coronary artery disease, but it is not a cure. Bypass surgery doesn't change the way arteries harden or narrow because of heart disease. And even after surgery, you can still get new blockages. These can occur in the new blood vessels that bypass the blocked arteries, as well as in the original coronary arteries.

What happens during and after bypass surgery?

You'll receive anesthesia before the surgery that will make you sleep. In most cases, bypass surgery is open-chest surgery. During the surgery, your chest will be open and your heart exposed. The surgeon makes a large cut, or incision, in your chest. He or she then cuts through your breastbone and spreads apart your rib cage.

The surgeon removes a healthy blood vessel—often from the leg—and attaches (grafts) it to the blocked artery. The new blood vessel bypasses the blocked artery to increase blood flow to the heart. You may need just one bypass graft, or you may need more. Some people have as many as two, three, or even four (double, triple, or quadruple bypass surgery). How many grafts you need depends on how many arteries are blocked and where.

When the surgery is complete, the doctor will use wire to put your rib cage back together and stitches to close the incision. The surgery can take 3 to 6 hours. You will stay in the hospital at least 3 to 8 days after the surgery. It can take 4 to 6 weeks to recover at home. Most people are able to return to work within 1 to 2 months after surgery.

See a slideshow on bypass surgery to see how it is done.

How do you know if you need bypass surgery?

Not everyone with coronary artery disease needs bypass surgery. Some people can be helped by angioplasty with stents. Others use medical therapy, which involves making lifestyle changes and taking medicines. Some people use both of those treatments. Your doctor is likely to recommend bypass surgery only if you will benefit from it and if those benefits are greater than the risks.

Your doctor may advise bypass surgery if:

Your left main heart artery is very narrow.
All three arteries of the heart are blocked or the amount of blood flowing through them is very low.
Your doctor thinks that bypass surgery will be more successful than angioplasty with stents.
You also need surgery to repair or replace a heart valve damaged by heart valve disease.
You have diabetes and two or more blocked arteries.
Your heart is having trouble pumping. This is called a decreased ejection fraction.

If only two of your arteries are blocked and neither of these is the left main artery, your choice may not be as clear. Talk with your doctor about the best treatment for you. This may depend on your age, your health, and how much your chest pain is affecting your quality of life.

What are the risks of bypass surgery?

Bypass surgery has been done for more than 30 years. In the United States, it is done more often than any other major surgery. But it has some serious risks.

The risks of bypass surgery include:

Death. Out of 100 people who have bypass surgery, 2 of them will have a serious complication that leads to death, while 98 of them will not.¹
Heart attack. Out of 100 people who have bypass surgery, 5 will have a heart attack, and 95 will not.²
Stroke. Out of 100 people who have the surgery, 1 to 5 will have a stroke, and 95 to 99 of them will not.³
Too much bleeding. This can lead to the need for a transfusion. This happens in 30 out of 100 people who have the surgery.⁴ This means that 70 out of 100 people don't have bleeding problems.

Other risks include return of angina, problems from anesthesia, and infections at the site of the chest incision. Some people also have memory loss and trouble thinking clearly. These problems are most common in older people and tend to improve several months after surgery.

The chances of having a serious problem with bypass surgery are higher if you are older than 70. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. It's important to talk with your doctor to find out how your health affects your risk.

How well does bypass surgery work?

Bypass surgery reduces angina and other symptoms of coronary artery disease. About 95 out of 100 people who have the surgery get relief from chest pain right away, while 5 out of 100 do not.³
More than 80 people out of 100 are still free of chest pain 5 years after surgery.³ People who have bypass surgery tend to have longer relief from repeat heart problems compared to other treatments.
Bypass surgery can increase your chances of living a longer life. More than 90 people out of 100 who have a bypass are still alive 5 years after surgery.³
How long a bypass lasts depends on how long the blood vessel grafts stay open. Most bypass grafts that are done with arteries stay open for 10 years or more. That makes it less likely that you will need a repeat surgery during that time.⁵

Lifestyle changes and medicines

The success of bypass surgery also depends on you. If you smoke and don't quit, you won't get the most benefit from bypass surgery. You may need to make some other big changes, like eating right and getting regular exercise. These changes will help your bypass grafts last and stay open longer. They will also give you the best chance of living a longer, healthier life.

If you are taking medicines for angina, to lower cholesterol, or to control blood pressure, it’s also important to take these every day. Along with lifestyle changes, these medicines can help you get the most benefit from bypass surgery.

Bypass surgery is not a cure for heart disease. That's why all of these things—eating right, not smoking, getting exercise, and taking medicines—are so important. Without them, you raise your risk of getting new blockages and needing another surgery.

Are there other treatment choices?

Other choices for you and your doctor to talk about are:

Angioplasty with stents. Angioplasty has fewer risks in some patients, and recovery is quicker than with surgery. But there is a greater chance that the artery will narrow again within 1 year. This means that you may need another angioplasty or bypass surgery to reopen it. For at least a year after angioplasty with stents, you may need to take medicine to reduce the risk of blood clots.
Should I have angioplasty?
Medicines and lifestyle changes. This is sometimes called medical therapy. This may be a choice for you if your chest pain is not affecting your quality of life. But in order to be successful, you'll need to follow a strict program of medicines and lifestyle changes, including eating right, getting regular exercise, and not smoking.

How well do other treatments work compared to bypass surgery?

Bypass surgery offers more relief from chest pain and other symptoms and the chance at a longer life compared with making lifestyle changes and taking medicines alone.⁶

Bypass surgery and angioplasty with stents have similar results in terms of improving your chances of living a longer life.⁷ But bypass surgery will help keep your arteries open longer. It’s also a better choice if your coronary arteries are narrow or if the amount of blood flowing through them is very low.

If you have diabetes, bypass surgery may be a better choice than angioplasty or medical therapy.

Ask your doctor what you can expect to happen if you have bypass surgery, compared with having other kinds of treatment like medical therapy or angioplasty with stents. Your doctor should be able to tell you why bypass surgery would be a good choice. Sometimes it helps to see another doctor to get a second opinion.

2. Compare Options

	Have coronary artery bypass surgery	Try other treatments first
What is usually involved?	The surgery can take 3 to 6 hours. You will stay in the hospital 3 to 8 days after the surgery. You will have a big scar on your chest from the incision. You may also have scars on your arms or legs where vessels were removed for grafting. It can take 4 to 6 weeks to recover at home. Most people are able to return to work within 1 to 2 months after surgery. You still need to make lifestyle changes.	You have angioplasty with stents or you have medical therapy alone, which means making lifestyle changes and taking medicines. If you have angioplasty, you will also have medical therapy.
What are the benefits?	Bypass surgery may lower your risk of heart attack. It can also help you live longer. Bypass surgery relieves chest pain (angina) right away. People who have bypass surgery tend to have longer relief from repeat heart problems compared to other treatments. If you have diabetes, bypass surgery may be a better choice than angioplasty or medical therapy.	Angioplasty with stents has the same benefit as bypass surgery when it comes to improving your chances of living longer. Angioplasty can relieve chest pain. Angioplasty has fewer risks than surgery. You avoid the risks from surgery, such as anesthesia, bleeding, possible stroke, and death. Recovery from angioplasty is quicker than from surgery. Medical therapy requires no recovery at all.
What are the risks and side effects?	Bypass surgery has rare risks that include death, heart attack, and stroke. The chances of having a serious problem with bypass surgery are higher if you are older than 70. Other risks from surgery include return of chest pain, problems from anesthesia, and infections at the site of the chest incision.	After angioplasty, your artery may narrow again within 1 year. That means you may need another angioplasty or bypass surgery to open it. Medical therapy only works if you follow a strict program of medicines and lifestyle changes, including eating right, getting regular exercise, and quitting smoking.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Coronary Artery Disease.

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 coronary artery 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 I need to do something about my heart. He wants me to have heart surgery. I guess my arteries are blocked up. My chest hurts when I'm out with the dog. But I'm not sure I have what it takes to come back after surgery. I have my hands full keeping my high blood pressure under control. I'm going to ask my doctor if there is something else I can do that isn't as risky but would give me some relief. "

— Saul, age 85

" When my doctor told me I had to have bypass surgery, I asked a lot of questions. He does so many of these surgeries every year. I know he thought a bypass would be best for me. But I had to make sure. I'm afraid of all the risks. So I asked another cardiologist what he thought. He looked at my angiograms. We talked about whether angioplasty with stents or making changes to the way I eat and the medicines I take could work. It turns out bypass surgery probably is the best choice for me. At least now I know why. "

— Gloria, age 67

" I love to cook and eat. I'm not a big fan of exercise, but I try to take a walk once a week. Everybody in my family has really high cholesterol, including me. I never took it seriously. But then I started having chest pains at work. My doctor says I have severe heart disease, but that I'm lucky. If I make some big changes in the way I eat, and if I take medicine and exercise every day, I might be able to avoid surgery. It's worth a try. "

— Juanita, age 56

3. Your Feelings

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

For me, the benefits of surgery outweigh the risks.

I'm worried about the risks of surgery.

More important

Equally important

More important

I've tried medicines and lifestyle changes, and they aren't working for me.

I'd like to find out if other nonsurgical treatments would work for me.

More important

Equally important

More important

I don't think that my health or my age is a good reason to avoid bypass surgery.

I think bypass surgery is too risky for me because of my health or my age.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

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.

Coronary artery bypass surgery

NOT having coronary artery bypass surgery.

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts

1. Is bypass surgery likely to relieve your chest pain?

Yes
No
I'm not sure

You are right. Most people who have bypass surgery can get relief from chest pain right away.

2. Will bypass surgery cure your heart disease?

Yes
No
I'm not sure

You're right. Bypass surgery can't cure heart disease, but it may help you live longer. You will still need to make lifestyle changes to get the most benefit from surgery.

3. Is bypass surgery the only treatment for coronary artery disease?

Yes
No
I'm not sure

You're right. Bypass surgery is just one treatment. Others include angioplasty with stents, medicines, and lifestyle changes.

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?

Not sure at all

Somewhat sure

Very sure

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.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Hannan EL, et al. (2005). Long-term outcomes of coronary artery bypass grafting versus stent implantation. New England Journal of Medicine, 352(21): 2174–2183.
Yokoyama Y, et al. (2000). Association between new electrocardiographic abnormalities after coronary revascularization and five-year cardiac mortality in BARI randomized and registry patients. American Journal of Cardiology, 86(8): 819–824.
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.
Karkouti K, et al. (2001). A multivariable model for predicting the need for blood transfusion in patients undergoing first-time elective coronary artery bypass surgery. Transfusion, 41(10): 1193–1203.
Peduzzi P, et al. (1998). Twenty-two year follow-up in the VA cooperative study of coronary artery bypass surgery for stable angina. American Journal of Cardiology, 81(12): 1393–1399.
Hueb W, et al. (2007). Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): A randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation, 115(9): 1082–1089.
Eagle KA, et al. (2004). ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 110(9): 1168–1176.