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Ask the doctor: How risky is bypass surgery?

Ask the doctor

How risky is bypass surgery?

Q. Like President Clinton, I have four very clogged coronary arteries (70% to 90% closed). My cardiologist pushed for bypass surgery but I resisted. A year later, the blockages have decreased somewhat. I haven't had much luck finding out about complications from and survival after bypass surgery. Can you help?

A. You would think that an expert from Harvard should be able to give you a simple answer to a simple question: What are the chances something bad will happen to me if I do or don't have bypass surgery? But I can't. Many factors determine one's odds of having complications during surgery. The number of blockages and the severity of the narrowings are less important than you might think. One key issue is whether your heart muscle has been damaged by prior heart attacks, and how severe any damage is. If your left ventricle has been weakened, the chances of having a problem during or soon after surgery goes up. Diabetes, kidney problems, and advanced age also increase your risk.

The risk of complications due to surgery and anesthesia is only half of the issue. You should also be asking, "How does the risk of problems from bypass surgery compare with my outlook if I use medications alone?" People with several narrowed arteries and a weakened left ventricle run a relatively high risk of complications with surgery. But they face even higher chances of trouble down the road if they don't have surgery. So most experts recommend this operation for people who fit this description.

For heart surgery, the term "high risk" means rates of death and major complications above the 1%–3% that is standard for routine cases at high-quality hospitals. But even if your risk of major complications is 5%–10%, there's a 90%–95% chance that things will go fine.

Heart surgery isn't a walk in the park for anyone. But it sounds as though you should give it serious thought and have another conversation with a physician who knows all the information about you, and can make an educated guess about your risk with and without surgery.

— Thomas H. Lee, M.D. Editor in Chief, Harvard Heart Letter

Last updated:	June 05, 2007