Cardiovascular disease is the leading cause of death in the United States,and thus its clinical and economic implications are enormous. In an increasingly cost-conscious economic environment, it is important to understand not only the effectiveness of treatments and technologies but also their cost-effectiveness. The authors review and summarize the evidence on cost-effectiveness of surgical versus medical treatments. This evidence should prove useful at the patient bedside as well as assist policymakers and third party payers in deciding what treatments to cover.