The goals of surgery for coronary artery disease (CAD) are to:

• Restore blood flow to the heart muscle.
• Relieve chest pain (angina).
• Allow you to maintain or resume a normal lifestyle. In some cases, surgery may allow you to live longer.

Although many people with CAD can be treated with medicine or the nonsurgical procedure angioplasty, sometimes coronary artery bypass surgery (CABG) is needed. This surgery routes blood flow around narrowed or blocked arteries by creating detours using healthy blood vessels. Coronary artery bypass surgery is usually an open-heart procedure.

Another type of surgery called transmyocardial laser revascularization (TMR) may be used along with CABG. TMR uses a laser beam to improve blood flow to heart muscle. TMR is not commonly used.

In angioplasty and stenting-also called percutaneous coronary intervention-thin flexible tubes (catheters) are inserted through arteries to open blood vessels. For more information on these procedures, see the Other Treatment section of this topic.

Surgery Choices

Coronary artery bypass surgery (coronary artery bypass grafting, or CABG) increases blood flow to the heart muscle tissue by using healthy artery or vein grafts to bypass diseased sections of coronary arteries.

In rare cases, transmyocardial laser revascularization (TMR) is used along with CABG surgery. TMR uses a laser beam to improve blood flow to heart muscle and may relieve chest pain.

What to Think About

Your choice of treatment depends on the number of blocked arteries you have and how badly they are blocked, the location of the blockage, as well as the specifics of your condition, your overall health, whether you have diabetes, and your personal preferences. In general, people with extensive CAD benefit more from bypass surgery than angioplasty.²³

• Significant blockage in the left main coronary artery usually requires surgery. Coronary artery bypass graft surgery, rather than angioplasty with stenting, is needed in most cases.
• If two or three heart arteries are blocked, the type of treatment will depend on the location and severity of the blockages, how they are affecting heart function, and how severe your symptoms are.
• If only one artery is blocked (other than the left main artery), medicine or angioplasty with stenting is most often used.
• If one of your heart valves is defective, bypass surgery combined with heart valve surgery may be required.

Understanding the advantages and disadvantages of each treatment is important in making the right decision. Consider:

• Other factors that affect the choice of treatment.
• Bypass versus angioplasty (usually with stenting).

Surgery is not the best option for everyone. Changing your lifestyle and taking medicine can be just as effective and may have less risk for some people.

People who have heart surgery at hospitals that do a large number of heart surgeries tend to have better results than those who have surgery at hospitals that do fewer heart surgeries.