The death of Kaua'i Mayor Bryan Baptiste on Sunday, nine days after a heart bypass procedure, came as a shock to family, friends and constituents who knew him.

But it also was a surprise to the local health community, given the acceptance of the surgery that has grown over the past 30 years and which is now commonplace throughout the country. Baptiste died of an apparent cardiac arrest.

Coronary heart bypass surgery typically involves repair of problems caused by a clogged heart artery with a "bypass" around the area using the graft of arteries or veins taken from elsewhere in the body. There were 652 bypass surgeries performed in the state last year, according to the Hawaii Health Information Corp.

Nationally, about a half million of the procedures are done yearly. Well-known figures including former President Bill Clinton, Vice President Dick Cheney, talk-show host Larry King, comedian David Letterman and actress Patty Duke are among the millions who've had the surgery. Honolulu Mayor Mufi Hannemann had it in 2001.

"It's a very common operation," said Dr. Collin Dang, chief of cardiac surgery at Hawaii Medical Center East. He's performed thousands of the surgeries here since 1976. He said they can take 2 1/2 hours or longer, depending on their complexity.

In Baptiste's case, the surgery was done four days after problems were found during routine medical testing. Baptiste was operated on at The Queen's Medical Center, which has a reputation for having one of Hawai'i's best cardiac diagnosis and treatment programs and recently has undergone a $22 million upgrade of its heart center with state-of-the-art imaging equipment.

Baptist spent a week recovering at the hospital before being released, then stayed for a night on O'ahu before traveling back to Kaua'i on Saturday night. His office said paramedics were called to his home Sunday and attempted to resuscitate him after his heart apparently stopped.

Dang said patients typically spend five to seven days recuperating in hospitals following the operation, though healthier patients sometimes leave after three days. Full recovery takes three months.

He said deaths can occur in 2 percent to 3 percent of first-time patients during the surgery or within 30 days thereafter.

The risk is "there, but it's relatively low considering the alternative if you don't have this kind of operation," Dang said.

But the mortality risk can be much higher than average if someone is in a higher risk group, including people who have had several heart attacks, those with kidney failure and emphysema, or the elderly, he said.

Risks also go up for smokers and people who are overweight, aren't active and are in urgent need of the operation, according to the American Heart Association.

Coronary heart problems are considered a heart disease, which is the leading cause of death for men and women in Hawai'i and nationwide. Of the 8,988 Hawai'i deaths in 2005, 2,254 were linked to heart problems, state health figures show.