Overall mortality of bypass surgery is approximately 3%. The operative mortality in patients over age 70, especially in women, is high — 6.3% versus 3.8% for men. Low-risk patients may have a mortality as low as 1%, but in patients with left ventricular dysfunction and an EF of 30% or less, mortality is as high as 9%. Survival at one month and 1, 5, 10, and 15 years is 97, 95, 87, 76, and 60%, respectively (see Table 1).
B. Prolongation of Life
Improved survival may be achieved in patients with stable or unstable angina and serious blockage of arteries in the following types:
1. Individuals who have severe narrowing of the left main coronary artery before it divides; this is the anatomical lesion for which surgery is universally accepted and is fortunately rare
2. Individuals who have triple-vessel disease, that is, severe obstruction of the right coronary, the LAD, and the circumflex arteries, especially in patients with decreased function of the left ventricular muscle
3. If the LAD is blocked before its first branch, plus two other vessels have more than 80% obstruction and angioplasty is not possible
4. Left ventricular dysfunction
The EF, the amount of blood the ventricle puts out into the aorta with each beat, is an important measure of the strength of the heart muscle. Its value is expressed as a percentage. A normal EF is more than 50%, an EF of less than 30% carries a bad prognosis, and less than 25% is a very poor prognosis. Surgery is highly beneficial in patients with an EF between 30 and 45%. Therefore patients with triple- or double-vessel disease that includes the LAD and left ventricular dysfunction are best managed with bypass surgery rather than angioplasty with stent or medical therapy.

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