Bypass Surgery, Should I or Shouldn't I?

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.

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.
• Your choice may depend on the number of arteries that are blocked or which arteries are blocked. Talk with your doctor about the best treatment for you. The best treatment for you may also 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 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.

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 the middle or side of your chest. He or she may cut through your breastbone and spread 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 may 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.

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.

Your choice may depend on the number of arteries that are blocked or which arteries are blocked. Talk with your doctor about the best treatment for you. The best treatment for you may also depend on your age, your health, and how much your chest pain is affecting your quality of life.