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I have seen all your reports (attachment removed to protect the patient's identity). Heart surgery is not associated with blood pressure. High blood pressure is a risk factor for coronary artery disease, and controlling blood pressure with medicines and lifestyle modifications will slow the progression of coronary artery disease. High blood pressure is not caused by heart blockage. Heart blockage is also not caused by high blood pressure. Rather, high blood pressure is a risk factor for heart vessel blockage. Bypass surgery will provide blood to the heart, which is reduced by stenosed arteries. It has mortality benefit, which means it reduces the risk of death, reduces the risk of cardiac arrest, improves symptoms, and prevents the heart from weakening due to reduced blood supply. If done successfully by an experienced surgeon, the risk is minimal. Some risks which are common to all surgeries include pain, infection, bed rest, hospital admission. Other risks include chest infection due to ventilator, minimal chances if sterile measures are taken. But it will need a lot of stents to be placed in your coronary arteries with increased risk of blockage in stents, high cost, and no benefit in reducing the risk of death. Only symptoms may improve, but the risk of death is not decreased. A large number of stents will increase the risk of blockages which may cause heart attack and later weakening of heart muscles. All three vessels plus the left main artery are narrowed, which causes a high risk of heart attack, cardiac arrest at any time. One reason for no symptoms may be that blockages progressed slowly, and your father may have a sedentary lifestyle. Slow blockages cause new vessels to be developed automatically over time which provides blood to the heart via alternate roots. This is sometimes called "auto-bypass." But angiography does not mention new vessels. High blood pressure is a risk factor for coronary artery blockages. Blood Pressure needs to be controlled to reduce the risk. Angioplasty can be done, but it has a high future risk of stent thrombosis, as I mentioned. It should be attempted if the surgeon says that bypass is not possible and the patient is having chest pain despite maximum medicines. The other options are medicines, enhanced external counter pulsations (EECP), spinal cord stimulation, coronary sinus construction. But these are only beneficial in terms of chest pain symptoms and have no mortality benefit. Moreover, these techniques are used very less often in case when bypass and angioplasty, both are not possible, and despite maximum medicines, the patient has chest pain.