Coronary Artery Disease: Should I Have Bypass Surgery?
Coronary Artery Disease: Should I Have Bypass Surgery?Skip to the navigationYou 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?Get the factsYour options- Have coronary artery bypass surgery along with medical therapy (lifestyle changes and medicines).
- Don't have coronary artery bypass surgery. No matter what you choose, you still take medicines and make lifestyle changes.
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 your chances of living a longer
life. How well it can do this 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 several months.
- Whether you have surgery or not, making lifestyle changes 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.
FAQs 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. Recovery after surgery 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. Lifestyle changes and medicinesYou 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. - Angioplasty with stents, along with medicines and lifestyle changes. 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.
After angioplasty with stents, most people take medicine to reduce the risk of blood clots. You may take this medicine for at least 1 year.
- Medical therapy alone. You need to take medicines and make lifestyle changes with any treatment that you choose. But medical therapy alone may be a choice for you if your angina is not affecting your quality of life. The medicines help prevent blood clots, lower cholesterol, and manage blood pressure. Lifestyle changes include 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. Your doctor may recommend surgery if: - Your left main heart artery is very
narrow.
- The three larger 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 1
- Help some people live longer. Whether it could help you live longer depends on several things. These include your overall health and which arteries need to be bypassed. For example, the surgery may raise
your chances of living longer if you have diabetes and narrowing in your heart's larger arteries.footnote 2, footnote 3
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: - 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.
BenefitsAngina 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. Number of people alive 5 and 10 years after bypass surgery*footnote 4| | 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) Understanding the evidenceSome 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.
RisksTake 100 people who have bypass surgery. Complication rates in hospitals show people face these risks from bypass surgery: - Stroke: About 1 to 4 out of 100 people have a stroke during or soon after surgery. That means that about 96 to 99 people out of 100 don't have a stroke.footnote 5, footnote 6 Some risk factors can increase your risk for stroke. These include older age, diabetes, and high blood pressure. Talk to your doctor about your own risk.
- Deep infection of the incision: About 1 out of 100 people have a deep infection in the chest incision. This means that about 99 out of 100 don't have this problem.footnote 5
- Kidney problems: About 2 to 6 out of 100 people have kidney problems. So about 94 to 98 people out of 100 don't have kidney problems.footnote 5
- Death: About 1 to 5 out of 100 people die during or soon after surgery. About 95 to 99 people out of 100 survive the surgery.footnote 5
Compare your options | |
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What is usually involved? |
| |
|---|
What are the benefits? |
| |
|---|
What are the risks and side effects? |
| |
|---|
Have coronary artery
bypass surgery Have coronary artery
bypass surgery - The surgery can take 3 to 6 hours.
You will stay in the hospital 3 to 8 days after the surgery.
- You may have some pain from the chest incision for a while. Recovery at home from surgery can take 4 to 6 weeks. Most people are able
to go back to work in 1 to 2 months.
- You will take medicines and may need to make lifestyle changes (medical therapy).
- Bypass surgery can relieve angina symptoms partly or completely.
- Surgery can help some people live longer. Whether it will 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 angina symptoms coming back, problems
from anesthesia, and an infection in the chest incision.
Don't have bypass surgery Don't have bypass surgery- You have angioplasty and take medicines and make lifestyle changes.
- Or you take medicines and make lifestyle changes.
- 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.
- You may still have angina.
- A small number of people may not live as long as they might with bypass surgery. This may depend on how bad their heart disease is.
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. 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. 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. 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. 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. More important Equally important More important I want more relief from my angina. I can accept having a little angina as long as I can still do my daily activities. More important Equally important More important 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. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important 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. Leaning toward Undecided Leaning toward What else do you need to make your decision?1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure Your SummaryHere's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Next stepsWhich way you're leaningHow sure you areYour commentsKey concepts that you understoodKey concepts that may need reviewCredits | Author | Healthwise Staff |
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| 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 |
|---|
| Specialist Medical Reviewer | Robert A. Kloner, MD, PhD - Cardiology |
|---|
| Specialist Medical Reviewer | John B. Wong, MD - Internal Medicine |
|---|
References Citations - 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.
- Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354-e471.
- Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
- Yusuf S, et al. (1994). Effect of coronary artery bypass graft surgery on survival: Overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet, 344(8922): 563-570.
- Shahian DM, et al. (2009). Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1-Coronary artery bypass grafting surgery. Annals of Thoracic Surgery, 88(1):S2-S22. DOI: 10.1016/j.athoracsur.2009.05.053. Accessed October 16, 2015.
- Bucerius J, et al. (2003). Stroke after cardiac surgery: A risk factor analysis of 16,184 consecutive adult patients. Annals of Thoracic Surgery, 75(2): 472-478. DOI: 10.1016/S0003-4975(02)04370-9. Accessed October 22, 2015.
Other Works Consulted - Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
- Hillis LD, et al. 2011 ACCF/AHA Guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(23): e652-e735.
- Kulik A, et al. (2015). Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association. Circulation, 131(10): 927-964. DOI: 10.1161/CIR.0000000000000182. Accessed April 6, 2015.
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. - 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 FactsYour options- Have coronary artery bypass surgery along with medical therapy (lifestyle changes and medicines).
- Don't have coronary artery bypass surgery. No matter what you choose, you still take medicines and make lifestyle changes.
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 your chances of living a longer
life. How well it can do this 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 several months.
- Whether you have surgery or not, making lifestyle changes 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.
FAQs What is coronary artery bypass surgery? 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. Recovery after surgery 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. Lifestyle changes and medicinesYou 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. 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 lifestyle changes (medical therapy). Others use medical therapy alone. - Angioplasty with stents, along with medicines and lifestyle changes. 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.
After angioplasty with stents, most people take medicine to reduce the risk of blood clots. You may take this medicine for at least 1 year.
- Medical therapy alone. You need to take medicines and make lifestyle changes with any treatment that you choose. But medical therapy alone may be a choice for you if your angina is not affecting your quality of life. The medicines help prevent blood clots, lower cholesterol, and manage blood pressure. Lifestyle changes include 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 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: - Your left main heart artery is very
narrow.
- The three larger 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.1
- Help some people live longer. Whether it could help you live longer depends on several things. These include your overall health and which arteries need to be bypassed. For example, the surgery may raise
your chances of living longer if you have diabetes and narrowing in your heart's larger arteries.2, 3
What are the risks of bypass surgery? 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: - 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.
What do numbers tell us about benefits and risks of bypass surgery?BenefitsAngina 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. Number of people alive 5 and 10 years after bypass surgery*4| | 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) Understanding the evidenceSome 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.
RisksTake 100 people who have bypass surgery . Complication rates in hospitals show people face these risks from bypass surgery: - Stroke: About 1 to 4 out of 100 people have a stroke during or soon after surgery. That means that about 96 to 99 people out of 100 don't have a stroke.5, 6 Some risk factors can increase your risk for stroke. These include older age, diabetes, and high blood pressure. Talk to your doctor about your own risk.
- Deep infection of the incision: About 1 out of 100 people have a deep infection in the chest incision. This means that about 99 out of 100 don't have this problem.5
- Kidney problems: About 2 to 6 out of 100 people have kidney problems. So about 94 to 98 people out of 100 don't have kidney problems.5
- Death: About 1 to 5 out of 100 people die during or soon after surgery. About 95 to 99 people out of 100 survive the surgery.5
2. Compare your options| | Have coronary artery
bypass surgery | Don't have bypass surgery |
|---|
| 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 may have some pain from the chest incision for a while. Recovery at home from surgery can take 4 to 6 weeks. Most people are able
to go back to work in 1 to 2 months.
- You will take medicines and may need to make lifestyle changes (medical therapy).
| - You have angioplasty and take medicines and make lifestyle changes.
- Or you take medicines and make lifestyle changes.
- You may have angioplasty or bypass surgery later.
|
|---|
| What are the benefits? | - Bypass surgery can relieve angina symptoms partly or completely.
- Surgery can help some people live longer. Whether it will help you depends on a few things, including which arteries need to be bypassed and whether you have diabetes.
| - You avoid the risks of bypass surgery.
- Angioplasty with medical therapy, or medical therapy alone, can relieve angina.
|
|---|
| What are the risks and side effects? | - 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 angina symptoms coming back, problems
from anesthesia, and an infection in the chest incision.
| - You may still have angina.
- A small number of people may not live as long as they might with bypass surgery. This may depend on how bad their heart disease is.
|
|---|
Personal storiesPersonal 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." "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." "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." "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." 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. More important Equally important More important I want more relief from my angina. I can accept having a little angina as long as I can still do my daily activities. More important Equally important More important 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. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important 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. Leaning toward Undecided Leaning toward 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? That's right. Both angioplasty along with medical therapy and medical therapy alone can also relieve angina symptoms. Which treatment you choose depends on your overall health, how many arteries are narrowed, and where they are. It also depends on how you feel about the risks of and recovery from surgery. 2.
Will bypass surgery cure your heart disease? You're right. Bypass surgery can't cure heart disease. You will still need to take medicine and make lifestyle changes to get the most benefit from surgery. 3.
Can bypass surgery help people live longer? That's right. Surgery can help some people live longer. Whether it can help you live longer depends in part on your overall health and which arteries need to be bypassed. Decide what's next1.
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? Certainty1.
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. Credits | 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 |
|---|
| Specialist Medical Reviewer | Robert A. Kloner, MD, PhD - Cardiology |
|---|
| Specialist Medical Reviewer | John B. Wong, MD - Internal Medicine |
|---|
References Citations - 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.
- Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354-e471.
- Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
- Yusuf S, et al. (1994). Effect of coronary artery bypass graft surgery on survival: Overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet, 344(8922): 563-570.
- Shahian DM, et al. (2009). Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1-Coronary artery bypass grafting surgery. Annals of Thoracic Surgery, 88(1):S2-S22. DOI: 10.1016/j.athoracsur.2009.05.053. Accessed October 16, 2015.
- Bucerius J, et al. (2003). Stroke after cardiac surgery: A risk factor analysis of 16,184 consecutive adult patients. Annals of Thoracic Surgery, 75(2): 472-478. DOI: 10.1016/S0003-4975(02)04370-9. Accessed October 22, 2015.
Other Works Consulted - Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
- Hillis LD, et al. 2011 ACCF/AHA Guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(23): e652-e735.
- Kulik A, et al. (2015). Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association. Circulation, 131(10): 927-964. DOI: 10.1161/CIR.0000000000000182. Accessed April 6, 2015.
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August 2, 2016 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. Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354-e471. Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014. Yusuf S, et al. (1994). Effect of coronary artery bypass graft surgery on survival: Overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet, 344(8922): 563-570. Shahian DM, et al. (2009). Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1-Coronary artery bypass grafting surgery. Annals of Thoracic Surgery, 88(1):S2-S22. DOI: 10.1016/j.athoracsur.2009.05.053. Accessed October 16, 2015. Bucerius J, et al. (2003). Stroke after cardiac surgery: A risk factor analysis of 16,184 consecutive adult patients. Annals of Thoracic Surgery, 75(2): 472-478. DOI: 10.1016/S0003-4975(02)04370-9. Accessed October 22, 2015. Last modified on: 8 September 2017
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