Routine, but never minor, surgery: Get a second opinion if you're in doubt.


In 2005 doctors performed about 280,000 bypass surgeries to route new vessels around blocked arteries and 800,000 angioplasties to open blocked arteries. Another 100,000 Americans had heart valves surgically repaired or replaced.

If your doctor says you need an intervention to fix or protect your heart, you'll have some pressing questions.

What type of procedure is the best choice for you?

What are the risks?

What kinds of improvements can you expect?

Can surgery extend your life?

While heart surgery can't cure heart disease, it should relieve chest pain and help you live longer.

Patients with serious coronary artery disease who undergo bypass surgery are nearly 50% more likely to be alive in five years than patients who receive drug treatment alone.

Angioplasties can also relieve chest pain, but the results are not as lasting. More than 40% of the patients who receive angioplasty need bypass surgery within a decade.

Long-term survival following the two procedures is just about the same, according to a recent overview of both by researchers at Stanford University School of Medicine. Results for almost 10,000 patients from 23 clinical trials in the United States and Europe showed 98.2% survival for bypass surgery and 98.9% for angioplasty.

Risks versus benefits of bypass

If your life isn't in immediate peril, you should take time to weigh the pros and cons of any approach. Major surgery is always risky, but a minor procedure may not give you the relief you want. "No surgeon should be offended if you get a second or third opinion," says heart surgeon Robert Jones, MD, of Duke University Medical Center in Durham, N.C.

Fortunately fewer patients are facing such dilemmas. The number of bypasses performed each year has dropped by roughly a third in the past decade, and Jones believes that angioplasties will soon be on the decline too.

The main reason: Medicines such as statins and beta-blockers make it easier than ever to live with heart disease. "Patients aren't as likely to be in horrible pain as they used to be," Dr. Jones says. "There's often no need for angioplasty."