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.

Bypass surgery has been done for more than 40 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, and 98 of them will not.¹
• Heart attack. Out of 100 people who have bypass surgery, about 1 will have a heart attack soon after the surgery, and 99 will not.²
• Stroke. Out of 100 people who have the surgery, 3 will have a stroke, and 97 of them will not.³
• Too much bleeding. This can lead to the need for a transfusion. This happens in 3 to 5 out of 100 people who have the surgery. This means that 95 to 97 out of 100 people don't have bleeding problems.³

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.

• 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.⁴
• More than 80 people out of 100 are still free of chest pain 5 years after surgery.⁴ 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.⁴
• How long a bypass lasts depends on how long the blood vessel grafts stay open. The risk of needing another surgery gets higher each year. After 5 years, about 2 out of 100 people need another surgery. After 10 years, 7 out of 100 people need another surgery.¹

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.

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 will likely take medicine to reduce the risk of blood clots.
• 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.

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.

Bypass surgery and angioplasty with stents have similar results in terms of improving your chances of living a longer life. But bypass surgery may help keep your arteries open longer.

If you have diabetes, bypass surgery may be a better choice than angioplasty or medical therapy. But your treatment also depends on your health, how serious your heart disease is, and if medicines are working to relieve your symptoms.

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.