Objective: to examine gender differences in access to cardiac surgery in a nationally representative sample. Design: nationwide cross sectional household based survey (Health Survey for England). Setting: private households in England around 1993 and 1994. Subjects: 1708 subjects reporting a history of either doctor diagnosed angina or heart attack from a stratified random sample of 32?378 people aged 16 and above. Outcome measure: the proportion reporting having had cardiac surgery or on a waiting list. Results: 13.5% reported previous (n=206) or pending (n=25) cardiac surgery. Men were more likely than women to have had or to be waiting for cardiac surgery (19.1% of men versus 6.8% of women, X2 54.7, P<0.001). This finding was consistent regardless of age group and across three regional areas. The unadjusted odds ratio for cardiac surgery for men versus women was 3.3 (95% CI 2.3, 4.5, P<0.001) and was only slightly attenuated to 2.8 (95% CI 1.9, 4.0, P<0.001), after adjustment for other factors. The gender difference remained even when analysis was restricted to subjects reporting a previous heart attack, and after statistical adjustment for disease severity. Conclusion: women are less likely than men to receive cardiac surgery across all age groups and regional areas. These results include private operations and adjust for individual behavioural data. Neither disease severity or co-morbidity explains these discrepancies. Further studies are required to determine why this inequality occurs and how it can be addressed.