What is coronary artery bypass surgery?

As seen above, a coronary blockage can be angioplastied or stented. Some patients, however, are not good candidates for angioplasty. These include patients that have blockages in all three coronary arteries or who have anatomy that is not amenable to angioplasty, such as a completely (100%) occluded artery. In these patients, coronary bypass, or "open heart surgery," is considered. Coronary bypass involves taking a vein or artery (from the chest wall, leg, or arm) and using it as a bypass conduit by sewing one end to the aorta and the other end to the coronary artery distal to the place of blockage. Coronary bypass surgery is an excellent procedure that generally provides good long term relief of angina and, in patients with a weakened heart or disease of the "left main artery," prolongs life span.

Large clinical trials have been done comparing coronary bypass surgery and angioplasty. These trials have shown no difference in long term survival between patients who undergo bypass surgery versus those who undergo angioplasty. Patients undergoing angioplasty tend to have a higher incidence of recurrent angina due to restenosis, necessitating repeat angioplasty procedures, whereas coronary bypass patients have a lower incidence of recurrent chest pain. However, coronary bypass surgery is a much more invasive procedure involving a longer hospitalization and higher short term incidence of complications.