Coronary Artery Disease: Should I Have Bypass Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Coronary Artery Disease: Should I Have Bypass Surgery?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

Have coronary artery bypass surgery along with medical therapy (lifestyle changes and medicines).
Don't have coronary artery bypass surgery. No matter what you choose, you still take medicines and make lifestyle changes.

This decision is for people who have stable angina and whose doctor has said bypass surgery may be an option for them. Stable angina means that you can usually predict when your symptoms will happen. You probably know what things cause your angina. For example, you know how much activity usually causes your angina.

Key points to remember

Bypass surgery can relieve angina symptoms such as chest pain or pressure. Most people who have bypass surgery get relief from angina.
Bypass surgery might improve your chances of living a longer life. How well it can do this depends on several things, including which arteries are narrowed, how many are narrowed, and whether you have other health problems such as diabetes.
Most of the time, bypass surgery is open-chest surgery. Its risks include heart attack, stroke, and death. Recovery usually takes several months.
Whether you have surgery or not, making lifestyle changes and taking medicine give you the best chance of living a longer, healthier life.
As you decide about surgery, think about what is most important to you. Talk to your doctor about what you hope surgery could do to improve your symptoms or help you live longer. The long-term benefits of surgery may or may not outweigh the short-term risks for you.

FAQs

What is coronary artery bypass surgery?

Bypass surgery—also called coronary artery bypass graft surgery—helps improve blood flow to the heart in people with severe coronary artery disease.

In most cases, bypass surgery is open-chest surgery. The surgeon connects, or grafts, a healthy blood vessel from another part of your body to the narrowed coronary artery. The grafted blood vessel goes around (bypasses) the narrowed part of the artery. This makes a new path for blood to your heart muscle.

Most people have bypasses in two or more arteries. How many you need depends on how many arteries, and which ones, are narrowed.

Bypass surgery is not a cure for heart disease. The surgery doesn't change the way arteries harden or narrow because of heart disease. And it doesn't bypass all the narrowing that you may have in your arteries.

Even after surgery, you can still get new places in your arteries that are narrowed. This can happen in the new blood vessels used in the bypass, as well as in the other arteries. If this happens, you may need another surgery or angioplasty with stents. That's why after surgery you still need medicines and lifestyle changes to give you the best chance of living a longer, healthier life.

Recovery after surgery

You will stay in the hospital at least 3 to 8 days after the surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. Most people are able to go back to work 1 to 2 months after surgery.

Lifestyle changes and medicines

You can do things after surgery to help yourself stay healthy and prevent problems. Medicines and a healthy lifestyle—known as medical therapy—can help your bypass grafts last and stay open longer. Medical therapy also can lower your risk of a heart attack or stroke.

You will likely take medicines to prevent blood clots, lower cholesterol, and manage blood pressure. You may need to make lifestyle changes. These include eating right, being active, and not smoking. It also means losing weight or staying at a healthy weight. A cardiac rehab program can help you make these changes.

What are your options if you don't have surgery?

Surgery isn't right for everyone. Some people can be helped by angioplasty along with medicines and lifestyle changes (medical therapy). Others use medical therapy alone.

Angioplasty with stents, along with medicines and lifestyle changes. Angioplasty is done through a blood vessel, so it is less invasive than surgery. The procedure has fewer risks for some people. Recovery is quicker than with surgery. After angioplasty with stents, most people take medicine to reduce the risk of blood clots. You may take this medicine for at least 1 year.
Medical therapy alone. You need to take medicines and make lifestyle changes with any treatment that you choose. But medical therapy alone may be a choice for you if your angina is not affecting your quality of life. The medicines help prevent blood clots, lower cholesterol, and manage blood pressure. Lifestyle changes include eating healthy foods, being physically active, staying at a healthy weight, and not smoking.

One of these treatments may be an option for you. It depends on your age, your other health problems, and how severe your heart disease is. It also depends on what you want. You and your doctor can decide together whether bypass surgery or another treatment is right for you.

How do you know if bypass surgery might help you?

You may have several tests to see if a bypass could help you. You may have had an angiogram that showed your doctor the location and amount of narrowing in your arteries. Your doctor also may have checked how well your heart is pumping blood.

Whether a bypass is an option for you depends on several things. These include which coronary arteries are narrowed, your age, and other health problems that you may have. It also depends on how much your angina keeps you from doing your daily activities and enjoying your life.

Your doctor may recommend surgery if:

Your left main heart artery is very narrow.
The three larger arteries of the heart are narrowed.
You have diabetes, and two or more of the larger arteries are narrowed.
The benefits of surgery for you are greater than the risks.

As you decide about surgery, think about what is most important to you. Talk to your doctor about what you hope surgery could do to improve your symptoms or lengthen your life. The benefits of surgery may or may not outweigh the risks for you.

What are the benefits of bypass surgery?

Bypass surgery can:

Relieve angina symptoms and improve quality of life. You may be able to do more of your daily activities.^{footnote 1}
Help some people live longer. Whether it could help you live longer depends on several things. These include your overall health and which arteries need to be bypassed. For example, the surgery may raise your chances of living longer if you have diabetes and narrowing in your heart's larger arteries.^{footnote 2,} ^{footnote 3}

What are the risks of bypass surgery?

Bypass surgery has been done for more than 40 years. In Canada and the United States, it is one of the most common major surgeries. But it has some risks.

The chances of having a serious problem with bypass surgery increase with age. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. Your doctor can help you understand what your risk for problems is.

The risks during or soon after bypass surgery include:

Infection.
Kidney problems.
Atrial fibrillation.
Heart attack.
Stroke.
Short-term problems with thinking and memory. This is more common in older people. It tends to get better within several months of surgery.
Death.

What do numbers tell us about benefits and risks of bypass surgery?

Benefits

Angina relief: In studies, about 84 out of 100 people who had bypass surgery had angina relief after 1 year. This relief lasted at least 5 years.* (Some of these people had another procedure that could have added to their angina relief.)^{footnote 1}

*Based on the best available evidence (evidence quality: moderate)

Living longer: Bypass can help some people live longer. How well bypass might help you live longer depends on several things, including which coronary arteries need to be bypassed and how bad your heart disease is. It also can depend on other conditions that you have, such as diabetes.

Number of people alive 5 and 10 years after bypass surgery* ^{footnote 4}
	After 5 years	After 10 years
Bypass surgery plus medical therapy	About 90 out of 100 are alive; about 10 out of 100 aren't.	About 73 out of 100 are alive; about 27 out of 100 aren't.
Medical therapy alone	About 84 out of 100 are alive; about 16 out of 100 aren't.	About 69 out of 100 are alive; about 31 aren't.

*Based on the best available evidence (evidence quality: moderate)

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence. The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Risks

Take 100 people who have bypass surgery. Complication rates in hospitals show people face these risks from bypass surgery:

Stroke: About 1 to 4 out of 100 people have a stroke during or soon after surgery. That means that about 96 to 99 people out of 100 don't have a stroke.^{footnote 5,} ^{footnote 6} Some risk factors can increase your risk for stroke. These include older age, diabetes, and high blood pressure. Talk to your doctor about your own risk.
Deep infection of the incision: About 1 out of 100 people have a deep infection in the chest incision. This means that about 99 out of 100 don't have this problem.^{footnote 5}
Kidney problems: About 2 to 6 out of 100 people have kidney problems. So about 94 to 98 people out of 100 don't have kidney problems.^{footnote 5}
Death: About 1 to 5 out of 100 people die during or soon after surgery. About 95 to 99 people out of 100 survive the surgery.^{footnote 5}

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Have coronary artery bypass surgery Have coronary artery bypass surgery

The surgery can take 3 to 6 hours. You will stay in the hospital 3 to 8 days after the surgery.
You may have some pain from the chest incision for a while. Recovery at home from surgery can take 4 to 6 weeks. Most people are able to go back to work in 1 to 2 months.
You will take medicines and may need to make lifestyle changes (medical therapy).

Bypass surgery can relieve angina symptoms partly or completely.
Surgery can help some people live longer. Whether it will help you depends on a few things, including which arteries need to be bypassed and whether you have diabetes.

Bypass surgery has short-term risks that include heart attack, stroke, kidney problems, and death. Your risk depends, in part, on your medical problems.
Other risks from surgery include angina symptoms coming back, problems from anesthesia, and an infection in the chest incision.

Don't have bypass surgery Don't have bypass surgery

You have angioplasty and take medicines and make lifestyle changes.
Or you take medicines and make lifestyle changes.
You may have angioplasty or bypass surgery later.

You avoid the risks of bypass surgery.
Angioplasty with medical therapy, or medical therapy alone, can relieve angina.

You may still have angina.
A small number of people may not live as long as they might with bypass surgery. This may depend on how bad their heart disease is.

Personal stories about coronary artery bypass surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I never thought twice about whether bypass surgery was right for me. After my heart attack, I wanted to do everything I could to get healthier. I started exercising and eating better and taking medicines. But it didn't help my chest pain, and I couldn't do all the things I wanted to do. I knew it was time to have the surgery.

Alan, age 70

My doctor tells me that some of my heart arteries are too narrow. And that's causing my chest pain. She thinks surgery is an option for me, so we talked about it. I want to feel better and avoid a heart attack, but I can also do this without having surgery. I worry about having a stroke because of the surgery. So I've decided to keep taking medicines, exercising, and eating a heart-healthy diet and see if they improve my chest pain.

Saul, age 85

When my doctor and I talked about bypass surgery, I asked a lot of questions. I'm afraid of the risks and the long recovery. But my doctor explained why surgery is a good choice for me. It's because of which arteries need to be operated on. So I think I'm willing to accept the risks of the surgery. I want to be around for my husband and kids.

Gloria, age 67

A couple of people in my family have heart disease. I never thought I'd have it too. But then I started having some pressure in my chest. I had some tests, and my doctor says I have severe heart disease. He said I could consider surgery or stents. But he said I also could try changing some habits. So that's what I want to do. I love to cook and eat, so I am going to try some healthy recipes. And I'm going to take my medicines and walk every day.

Juanita, age 56

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have bypass surgery

Reasons not to have bypass surgery

I am willing to accept the risks of surgery.

I'm worried about the risks of surgery.

More important

Equally important

More important

I want more relief from my angina.

I can accept having a little angina as long as I can still do my daily activities.

More important

Equally important

More important

I'm willing to have a surgery that has a long recovery.

I don't want to have a surgery that has a long recovery.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having coronary artery bypass surgery

NOT having coronary artery bypass surgery.

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Print Summary

Credits and References

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Robert A. Kloner MD, PhD - Cardiology
Primary Medical Reviewer	John B. Wong MD - Internal Medicine

References

Citations

Bravata DM, et al. (2007). Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine, 147(10): 703–716.
Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354–e471.
Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
Yusuf S, et al. (1994). Effect of coronary artery bypass graft surgery on survival: Overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet, 344(8922): 563–570.
Shahian DM, et al. (2009). Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1—Coronary artery bypass grafting surgery. Annals of Thoracic Surgery, 88(1):S2–S22. DOI: 10.1016/j.athoracsur.2009.05.053. Accessed October 16, 2015.
Bucerius J, et al. (2003). Stroke after cardiac surgery: A risk factor analysis of 16,184 consecutive adult patients. Annals of Thoracic Surgery, 75(2): 472–478. DOI: 10.1016/S0003-4975(02)04370-9. Accessed October 22, 2015.

Coronary Artery Disease: Should I Have Bypass Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have coronary artery bypass surgery along with medical therapy (lifestyle changes and medicines).
Don't have coronary artery bypass surgery. No matter what you choose, you still take medicines and make lifestyle changes.

Key points to remember

Bypass surgery can relieve angina symptoms such as chest pain or pressure. Most people who have bypass surgery get relief from angina.
Bypass surgery might improve your chances of living a longer life. How well it can do this depends on several things, including which arteries are narrowed, how many are narrowed, and whether you have other health problems such as diabetes.
Most of the time, bypass surgery is open-chest surgery. Its risks include heart attack, stroke, and death. Recovery usually takes several months.
Whether you have surgery or not, making lifestyle changes and taking medicine give you the best chance of living a longer, healthier life.
As you decide about surgery, think about what is most important to you. Talk to your doctor about what you hope surgery could do to improve your symptoms or help you live longer. The long-term benefits of surgery may or may not outweigh the short-term risks for you.

FAQs

What is coronary artery bypass surgery?

Bypass surgery—also called coronary artery bypass graft surgery—helps improve blood flow to the heart in people with severe coronary artery disease.

Most people have bypasses in two or more arteries. How many you need depends on how many arteries, and which ones, are narrowed.

Recovery after surgery

Lifestyle changes and medicines

What are your options if you don't have surgery?

Surgery isn't right for everyone. Some people can be helped by angioplasty along with medicines and lifestyle changes (medical therapy). Others use medical therapy alone.

Angioplasty with stents, along with medicines and lifestyle changes. Angioplasty is done through a blood vessel, so it is less invasive than surgery. The procedure has fewer risks for some people. Recovery is quicker than with surgery. After angioplasty with stents, most people take medicine to reduce the risk of blood clots. You may take this medicine for at least 1 year.
Medical therapy alone. You need to take medicines and make lifestyle changes with any treatment that you choose. But medical therapy alone may be a choice for you if your angina is not affecting your quality of life. The medicines help prevent blood clots, lower cholesterol, and manage blood pressure. Lifestyle changes include eating healthy foods, being physically active, staying at a healthy weight, and not smoking.

How do you know if bypass surgery might help you?

Your doctor may recommend surgery if:

Your left main heart artery is very narrow.
The three larger arteries of the heart are narrowed.
You have diabetes, and two or more of the larger arteries are narrowed.
The benefits of surgery for you are greater than the risks.

What are the benefits of bypass surgery?

Bypass surgery can:

Relieve angina symptoms and improve quality of life. You may be able to do more of your daily activities.¹
Help some people live longer. Whether it could help you live longer depends on several things. These include your overall health and which arteries need to be bypassed. For example, the surgery may raise your chances of living longer if you have diabetes and narrowing in your heart's larger arteries.^2, ³

What are the risks of bypass surgery?

Bypass surgery has been done for more than 40 years. In Canada and the United States, it is one of the most common major surgeries. But it has some risks.

The risks during or soon after bypass surgery include:

Infection.
Kidney problems.
Atrial fibrillation.
Heart attack.
Stroke.
Short-term problems with thinking and memory. This is more common in older people. It tends to get better within several months of surgery.
Death.

What do numbers tell us about benefits and risks of bypass surgery?

Benefits

*Based on the best available evidence (evidence quality: moderate)

Number of people alive 5 and 10 years after bypass surgery* ⁴
	After 5 years	After 10 years
Bypass surgery plus medical therapy	About 90 out of 100 are alive; about 10 out of 100 aren't.	About 73 out of 100 are alive; about 27 out of 100 aren't.
Medical therapy alone	About 84 out of 100 are alive; about 16 out of 100 aren't.	About 69 out of 100 are alive; about 31 aren't.

*Based on the best available evidence (evidence quality: moderate)

Understanding the evidence

The information shown here is based on the best available evidence. The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Risks

Take 100 people who have bypass surgery . Complication rates in hospitals show people face these risks from bypass surgery:

Stroke: About 1 to 4 out of 100 people have a stroke during or soon after surgery. That means that about 96 to 99 people out of 100 don't have a stroke.^5, ⁶ Some risk factors can increase your risk for stroke. These include older age, diabetes, and high blood pressure. Talk to your doctor about your own risk.
Deep infection of the incision: About 1 out of 100 people have a deep infection in the chest incision. This means that about 99 out of 100 don't have this problem.⁵
Kidney problems: About 2 to 6 out of 100 people have kidney problems. So about 94 to 98 people out of 100 don't have kidney problems.⁵
Death: About 1 to 5 out of 100 people die during or soon after surgery. About 95 to 99 people out of 100 survive the surgery.⁵

2. Compare your options

	Have coronary artery bypass surgery	Don't have bypass surgery
What is usually involved?	The surgery can take 3 to 6 hours. You will stay in the hospital 3 to 8 days after the surgery. You may have some pain from the chest incision for a while. Recovery at home from surgery can take 4 to 6 weeks. Most people are able to go back to work in 1 to 2 months. You will take medicines and may need to make lifestyle changes (medical therapy).	You have angioplasty and take medicines and make lifestyle changes. Or you take medicines and make lifestyle changes. You may have angioplasty or bypass surgery later.
What are the benefits?	Bypass surgery can relieve angina symptoms partly or completely. Surgery can help some people live longer. Whether it will help you depends on a few things, including which arteries need to be bypassed and whether you have diabetes.	You avoid the risks of bypass surgery. Angioplasty with medical therapy, or medical therapy alone, can relieve angina.
What are the risks and side effects?	Bypass surgery has short-term risks that include heart attack, stroke, kidney problems, and death. Your risk depends, in part, on your medical problems. Other risks from surgery include angina symptoms coming back, problems from anesthesia, and an infection in the chest incision.	You may still have angina. A small number of people may not live as long as they might with bypass surgery. This may depend on how bad their heart disease is.

Personal stories

Personal stories about coronary artery bypass surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I never thought twice about whether bypass surgery was right for me. After my heart attack, I wanted to do everything I could to get healthier. I started exercising and eating better and taking medicines. But it didn't help my chest pain, and I couldn't do all the things I wanted to do. I knew it was time to have the surgery."

— Alan, age 70

"My doctor tells me that some of my heart arteries are too narrow. And that's causing my chest pain. She thinks surgery is an option for me, so we talked about it. I want to feel better and avoid a heart attack, but I can also do this without having surgery. I worry about having a stroke because of the surgery. So I've decided to keep taking medicines, exercising, and eating a heart-healthy diet and see if they improve my chest pain."

— Saul, age 85

"When my doctor and I talked about bypass surgery, I asked a lot of questions. I'm afraid of the risks and the long recovery. But my doctor explained why surgery is a good choice for me. It's because of which arteries need to be operated on. So I think I'm willing to accept the risks of the surgery. I want to be around for my husband and kids."

— Gloria, age 67

"A couple of people in my family have heart disease. I never thought I'd have it too. But then I started having some pressure in my chest. I had some tests, and my doctor says I have severe heart disease. He said I could consider surgery or stents. But he said I also could try changing some habits. So that's what I want to do. I love to cook and eat, so I am going to try some healthy recipes. And I'm going to take my medicines and walk every day."

— Juanita, age 56

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have bypass surgery

Reasons not to have bypass surgery

I am willing to accept the risks of surgery.

I'm worried about the risks of surgery.

More important

Equally important

More important

I want more relief from my angina.

I can accept having a little angina as long as I can still do my daily activities.

More important

Equally important

More important

I'm willing to have a surgery that has a long recovery.

I don't want to have a surgery that has a long recovery.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having coronary artery bypass surgery

NOT having coronary artery bypass surgery.

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Robert A. Kloner MD, PhD - Cardiology
Primary Medical Reviewer	John B. Wong MD - Internal Medicine

References

Citations

Bravata DM, et al. (2007). Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine, 147(10): 703–716.
Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354–e471.
Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
Yusuf S, et al. (1994). Effect of coronary artery bypass graft surgery on survival: Overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet, 344(8922): 563–570.
Shahian DM, et al. (2009). Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1—Coronary artery bypass grafting surgery. Annals of Thoracic Surgery, 88(1):S2–S22. DOI: 10.1016/j.athoracsur.2009.05.053. Accessed October 16, 2015.
Bucerius J, et al. (2003). Stroke after cardiac surgery: A risk factor analysis of 16,184 consecutive adult patients. Annals of Thoracic Surgery, 75(2): 472–478. DOI: 10.1016/S0003-4975(02)04370-9. Accessed October 22, 2015.

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