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.
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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.
Bypass surgery—also called coronary artery bypass graft surgery—helps improve blood flow to the heart 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.
Most 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 doesn't bypass all the narrowing 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 need another surgery or angioplasty with stents. That's why after surgery you still need medicines and lifestyle changes to give you the best chance of living a longer, healthier life.
You will stay in the hospital at least 3 to 8 days after the surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. Most people are able to go back to work 1 to 2 months after surgery.
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. You may need to make lifestyle changes. These include eating right, being active, and not smoking. It also means losing weight or staying at a healthy weight. A cardiac rehab program can help you make these changes.
Surgery isn't right for everyone. Some people can be helped by angioplasty along with medicines and lifestyle changes (medical therapy). Others use medical therapy alone.
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.
Your doctor may recommend surgery if:
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:
Bypass surgery has been done for more than 40 years. In the United States, it is one of the most common major surgeries. But it has some risks.
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:
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 1
*Based on the best available evidence (evidence quality: moderate)
Living longer: Bypass can help some people live longer. How well bypass might help you live longer depends on several things, including which coronary arteries need to be bypassed and how bad your heart disease is. It also can depend on other conditions that you have, such as diabetes.
| After 5 years | After 10 years | |
|---|---|---|
| Bypass surgery plus medical therapy | About 90 out of 100 are alive; about 10 out of 100 aren't. | About 73 out of 100 are alive; about 27 out of 100 aren't. |
| Medical therapy alone | About 84 out of 100 are alive; about 16 out of 100 aren't. | About 69 out of 100 are alive; about 31 aren't. |
*Based on the best available evidence (evidence quality: moderate)
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.
Take 100 people who have bypass surgery. Complication rates in hospitals show people face these risks from bypass surgery:
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What are the benefits? |
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What are the risks and side effects? |
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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 also 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 and see if they improve my chest pain.
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 my doctor explained why surgery is 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. He said I could consider surgery or stents. But he said I also could try changing some habits. So that's what I want to do. I love to cook and eat, so I am going to try some healthy recipes. And I'm going to take my medicines and walk every day.
Juanita, age 56
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:
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.
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology |
| Primary Medical Reviewer | E. Gregory Thompson MD - Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica MD - Family Medicine |
| Primary Medical Reviewer | Adam Husney MD - Family Medicine |
| Primary Medical Reviewer | Robert A. Kloner MD, PhD - Cardiology |
| Primary Medical Reviewer | John B. Wong MD - Internal Medicine |
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.
Bypass surgery—also called coronary artery bypass graft surgery—helps improve blood flow to the heart 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.
Most 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 doesn't bypass all the narrowing 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 need another surgery or angioplasty with stents. That's why after surgery you still need medicines and lifestyle changes to give you the best chance of living a longer, healthier life.
You will stay in the hospital at least 3 to 8 days after the surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. Most people are able to go back to work 1 to 2 months after surgery.
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. You may need to make lifestyle changes. These include eating right, being active, and not smoking. It also means losing weight or staying at a healthy weight. A cardiac rehab program can help you make these changes.
Surgery isn't right for everyone. Some people can be helped by angioplasty along with medicines and lifestyle changes (medical therapy). Others use medical therapy alone.
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.
Your doctor may recommend surgery if:
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:
Bypass surgery has been done for more than 40 years. In the United States, it is one of the most common major surgeries. But it has some risks.
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:
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.)1
*Based on the best available evidence (evidence quality: moderate)
Living longer: Bypass can help some people live longer. How well bypass might help you live longer depends on several things, including which coronary arteries need to be bypassed and how bad your heart disease is. It also can depend on other conditions that you have, such as diabetes.
| After 5 years | After 10 years | |
|---|---|---|
| Bypass surgery plus medical therapy | About 90 out of 100 are alive; about 10 out of 100 aren't. | About 73 out of 100 are alive; about 27 out of 100 aren't. |
| Medical therapy alone | About 84 out of 100 are alive; about 16 out of 100 aren't. | About 69 out of 100 are alive; about 31 aren't. |
*Based on the best available evidence (evidence quality: moderate)
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.
Take 100 people who have bypass surgery . Complication rates in hospitals show people face these risks from bypass surgery:
| 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? |
|
|
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 also 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 and see if they improve my chest pain."
— 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 my doctor explained why surgery is 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. He said I could consider surgery or stents. But he said I also could try changing some habits. So that's what I want to do. I love to cook and eat, so I am going to try some healthy recipes. And I'm going to take my medicines and walk every day."
— Juanita, age 56
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:
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.
1. Is bypass surgery the only way to relieve your angina symptoms?
2. Will bypass surgery cure your heart disease?
3. Can bypass surgery help people live longer?
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?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology |
| Primary Medical Reviewer | E. Gregory Thompson MD - Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica MD - Family Medicine |
| Primary Medical Reviewer | Adam Husney MD - Family Medicine |
| Primary Medical Reviewer | Robert A. Kloner MD, PhD - Cardiology |
| Primary Medical Reviewer | John B. Wong MD - Internal Medicine |
Current as of: August 31, 2020
Author: Healthwise Staff
Medical Review:Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology & E. Gregory Thompson MD - Internal Medicine & Martin J. Gabica MD - Family Medicine & Adam Husney MD - Family Medicine & Robert A. Kloner MD, PhD - Cardiology & John B. Wong MD - Internal Medicine
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