Financial arrangements for your medical care at our hospital must be made prior to or at the time of admission either through Insurance, Corporate Tie-up or Advance Deposit. It is recommended that you get an estimate of the treatment cost involved prior to admission.
An advance amount will have to be deposited depending on the estimate of the services to be availed.
In case of a corporate tie-up, please bring with you a signed letter from your company clearly accepting financial responsibility for all medical care. The Hospital will provide care in the ward specified by your company. Any deviation from the instructions will be billed directly to the patient.
You will be billed for services you receive based on our tariffs. An itemised statement of your account will be made available to you on request (this is not applicable for packages). You will be given interim bills and are requested to replenish the advance amount periodically
Your bill can be settled with Cash, Pay Orders, Demand Drafts, Debit/Credit Cards (Visa or MasterCard). The hospital does not accept cheques except for planned admissions where the cheque can be cleared before the admission.
Bypass is a major surgery and it has both serious as well minor complications. The complication rates depend upon retrospective or prospective clinical studies. Serious complications include stroke, deep sternal wound infection or life-threatening tachyarrhythmias. Temporary complications such as superficial infections, lung infections, and pleural effusion can be managed with conservative treatment. In this Video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute New Delhi talks about the major and minor complication rates in bypass surgery.
Normally, a person can drive from the very next day of the bypass surgery as there won’t be any problem with the functioning of his heart but the problem is of safety. The patient has to swirl while driving and this can pull his pectoral muscle leading to severe sternum pain. Driving is not recommended for at least 4 – 6 weeks after the bypass surgery.
In this Video, Dr.O.P. Yadava, CEO & Chief Cardiac Surgeon, N.H.I, New Delhi, talks about whether driving is safe after bypass surgery
Bypass surgery can be performed multiple times. In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, will talk about how many times we can undergo bypass surgery. Second time bypass has become a very standard procedure nowadays. As many of the patients are operated in the late 60’s and 70’s so the need for a second bypass surgery arises. There is no specific limit of times that a person can undergo bypass surgery. But with each number of surgeries, the risk also goes on increasing.
Whenever a bypass surgery is done, only arterial conduits are used which is then known as total arterial myocardial revascularization. It can be performed using various configurations. Free grafts, in situ grafts, single grafts or sequential grafts are used in bypass surgery. In sequential grafts, one conduit can be used to bypass two arteries. Dr. Yadava will also describe that a free graft can be attached to a pedicle graft and can-do T or Y configuration of total arterial revascularization known as T or Y grafts.
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about total arterial bypass surgery.
Robotic bypass heart surgeries are a type of minimally invasive heart surgery. Robots were introduced to perform robotic bypass surgery with equal human dexterity. Robotic surgery has advantages over open heart bypass surgery. Fourth-generation robots and how robotic surgery is gaining attraction. Also, the new arms of the robots have received good feedback and have become feasible in cardiac robotic surgery.
In this video, Dr.O.P. Yadava, CEO & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about why robotic bypass surgery was introduced.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, tells when the bypass surgery is done along with angiography. This type of surgery is known as hybrid cardiac surgery.
The results of total arterial bypass surgery are mostly superior to venous revascularization. Almost 10 – 15 % of the venous grafts are blocked by the end of one year. Whereas the patency rates of arterial grafts are high even at 10 – 20 years. Total arterial bypass surgery revascularization is done when a patient is young but it also depends upon various factors.
In this Video, Dr.O.P. Yadava talks about the criteria of total arterial bypass surgery and when it is done.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the advantages and complications of redo bypass surgery. Currently, redo bypass surgery is technically demanding.
Dr. Yadava tells us that there is no age limit for bypass surgery. With new techniques introduced, bypass surgery can be done in elderly patients.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about bypass surgery in low ejection fraction. The results of the bypass surgery are not very good if the heart is damaged.
After the bypass surgery, the viable myocardium recovers but the non-viable myocardium does not recover leading to ventricular dilatation and remodeling. Surgical remodeling is superior to medical therapy and improves the patient.
In this video, Dr. Yadava, CEO & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about Bypass Surgery With LV Volume Reduction.
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi tells us that technically the cardiac transplant is not a difficult operation. The main issues are the logistic problems in organ donation, preservation and ongoing follow-ups post-transplant.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the long-term results of cardiac transplants. The results of this transplant surgery are improving.
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the person who has undergone bypass surgery, as when he can enjoy his married life.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, tells us about when a person can return to work after bypass surgery. The patient can start with simple chores at home and get back to their normal desk job within four weeks.
It depends upon the control of risk factors with lifestyle modifications, following the medical treatment properly. It also depends upon how well the surgeon has done his job. He told that if arterial revascularization has been given then the results are for the long term and if veins are used then the chances of failure are higher. Hence, he says that control of blood pressure, lipids, control of diabetes status and weight control is very essential. Also, the patients should be involved in physical activities for long-term benefit after bypass surgery.
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the longevity of bypass surgery
With arterial graft, the results are for 20 years. The patency and results of these grafts also depend on the control of risk factors. Quitting smoking, regular physical activities and control of diet will prolong the efficacy of these grafts.
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about arterial graft
During the first year, in various studies, it is shown that bypass surgery does not reduce the total incidence of a heart attack. It only reduces the incidences of fatal heart attacks but overall heart attacks are not reduced.
The reason behind it is that the side branches, the microcirculation, each coronary arteries branches 10 – 14 times before it becomes a capillary, all these are not bypassed. The cholesterol can also clog in major arteries as well as microcirculation. Even after bypass surgery, there are certain areas that continue to be ischemic. If the graft has failed, then 3% of patients might get a heart attack within a year.
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the chances of a heart attack after bypass surgery
The results are seen in both the short term as well long term. In the short term, it is seen that diabetes is a systemic disease and so is atherosclerosis. Cholesterol gets deposited in the arteries of the heart, also in the arteries of the brain, kidneys or other vasculature. Thus, in these patients, there is multisystem involvement with increased chances of renal failure, CVA or wound infections in diabetes. These patients spend longer time in the hospital with higher mortality and morbidity. Long term results in terms of survival. Graft patency rates are lower in diabetics as compared to non-diabetics. In such patients, aggressive treatment is required for glycemic control.In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the results of Bypass Surgery in diabetics
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the results of Bypass Surgery in diabetics
Bypass can be done with renal artery stenosis, if the coronary anatomy is not critical. Renal artery stenting can be done before the bypass surgery to restore the kidney blood supply. The condition if the coronary artery is critical or the patient gets unstable angina. In such cases, first CABG should be done with certain precautions. He will discuss these precautions to be taken in critical patients. Also, avoid using nephrotoxic drugs in such patients.
In this video, Dr. OP. Yadava, explain whether the bypass surgery can be done along with renal artery stenosis
Bypass surgery can be done with coronary artery intervention which is also called simultaneous procedure. Dr. Yadava will explain the procedure with different models which are used. He will also talk about the advantages and disadvantages of the methods used. The simultaneous method is the best option for this type of surgery but the patient has to be selected carefully. The patient should be symptomatic and carotid stenosis should be significant.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Will discuss whether bypass surgery can be done with peripheral artery intervention. He tells us that bypass surgery can be done with peripheral artery intervention. It reduces hospitalization and is cost-effective. It can also be done under the same anaesthesia. Dr. Yadava will also explain the pros and cons of the intervention. Normally coronary bypass is done and the patient is allowed to recover. 4 – 6 weeks is generally recommended for recovery and then peripheral artery intervention is done. If the limb is threatened then both interventions are done under the same anaesthesia.
Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Will talk about how long to continue aspirin. Dr. Yadava tells us that aspirin has to be continued lifelong.
If the non-cardiac surgery is of emergent nature, it can be done at any time without any problem. There are no such contraindications for doing non-cardiac surgery immediately after bypass surgery. He further told that the problem arises when the patient has elective cardiac surgery. In such patients, it is recommended that the patient should recover which is generally 4 – 6 weeks and then the non-cardiac surgery is scheduled. He will also talk about the consequences if we stop the anti-platelets treatment for non-cardiac surgery and what can be done.
In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about when to do a non-cardiac surgery after bypass surgery.
The current recommendations for dual antiplatelet therapy are from 6 – 12 months. There are no adequate data available that suggests continuing the dual antiplatelet treatment beyond 12 months. Ideally, after a year one antiplatelet therapy should be stopped and continue with the other antiplatelet for life.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about how long to continue dual antiplatelet treatment.
The standard natural phases of venous grafts are three phases of occlusion: immediate which might be due to technical fault, fibro-endothelial hyperplasia might occur in 1 % of patients after a month. And the last phase is atherosclerosis which happens over one year and can block the coronary artery as well the graft. Overall, approximately 50 % of the venous grafts might get blocked over 10 years.
In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about venous graft.
The mode of payment is by Cash / Credit Card / Debit Cards (Visa or Master Cards).
Patient’s relatives may get a regular briefing regarding their patient’s condition from their treating Consultant. For fixing an appointment with the Consultant, the family members or relatives of the patients are requested to get in touch with the Floor coordinators at the Reception.
Before your operation, much of your body hair will be shaved off, especially from your chest and legs. You will probably be asked to shower and wash with antiseptic soap to remove bacteria from the skin. This reduces the chance of infection. You should remove personal items such as glasses, contact lenses, dentures, watches and jewellery and give them to family members for safekeeping.
You will be served a light meal, given the pre anaesthetic medications prescribed and will be asked to rest. A good night’s sleep is important, your body needs to be fresh and strong. Ask the doctor or the nurse any last-minute questions, tell them if you are feeling any discomfort or symptoms, you may suddenly develop at this stage.
Medications that will make you relaxed will be given about an hour before the operation. The medication will make you feel drowsy, so remain in bed and try not to move around too much.
You will be taken to the operation room at the pre appointed time, the anaesthesiologist will give you an anaesthetic that brings sleep and freedom from pain during the operation and then the operation will be performed.
Coronary artery bypass graft operations/ Open Heart Surgeries usually last from three to six hours. Their length depends upon what has to be done. Each operation varies in complexity, so its duration can only be estimated.
When your surgery is over you will be taken to the recovery area for your post-operative care. You will remain in this area until your condition is stable and you are ready to be transferred back to the ward. This usually takes two or three days. In this area, your heart function, lungs and urine output and other vital parameters are carefully monitored.
As soon as the operation is over, relatives will be informed about it and about the progress of the patient. One relative will be invited by the sister in charge in the intensive care unit to visit the patient and for direct first-hand viewing. Most patients at this stage would be unconscious, paralysed and on ventilator and therefore only viewing the patient and first-hand conversation with the intensive care doctor about the patient’s clinical condition is possible. Whenever the patient regains consciousness (usually within 4-6 hours), and when he is taken off ventilator (6-24 hours), the sister in charge will invite one relative to interact with the patient. Every day at 7'O Clock in the morning, patient's relatives can meet the intensive care doctor on duty, who will brief them about the progress of the patient. Any time if the relatives are uncomfortable, they can contact the reception desk, who would organize their meeting with the doctor on duty.
When you awake in the recovery room you will hear the sounds of equipments and be aware of activity within the unit. There will be a number of tubes and pieces of equipment attached to your body which are essential for your proper treatment.
An endotracheal (or breathing tube) will be in your mouth and passes through the vocal cords into the windpipe. While this tube is in place you will not be able to talk but the nurses are specially trained and will anticipate your needs. This tube is connected to a respiratory machine (Ventilator) which assists you with your breathing. When you are fully awake after the operation and no longer require assistance with your breathing, the tube will be removed.
The nurse will help you sit up in bed and cough vigorously to clear your lungs of secretions. For the next day or two, you will receive oxygen through a mask. In addition, you will have several tubes in your veins to administer fluid, blood and medications. These tubes will be removed one by one in the next one or two days.
A urinary catheter will drain your bladder continuously and enable the nurse to keep an accurate record of your urine output. Sometimes it may give you a feeling of pressure in your bladder and make you feel as if you need to urinate. This will usually be removed two days after surgery.
Drainage tubes are placed around your heart at the time of surgery and passed through the skin near the lower end of your chest incision. The drains prevent blood from accumulating around the heart during the postoperative phase. Sometimes small wires are taped on your lower chest. They have been placed at the time of surgery to regulate your heart rate if required. These wires will be removed before you go home.
Hospital has places where a patient's family and friends can wait during surgery. Be sure the reception knows where your family will be waiting during the surgery. The patient’s relatives can wait in the reception lobby or in relatives’ dormitory or in the respective rooms (in the case of Deluxe and Suite room patients). As soon as the operation is over relatives will be informed about it and about the progress of the patient, but no patient's relatives will be allowed to visit the patient till the patient is in the Surgical ICU.
Free access to relatives is not permitted in the recovery room. However, relatives will be kept informed about the progress of the patient. Every day at 7:30 AM duty doctor will brief your progress to your relatives. Relatives can sit in the reception lobby.
HOW LONG YOU WILL STAY IN RECOVERY AREA ?
Usually, on the 2nd or 3rd post-operative day, patients are shifted to the ward where under close observation, your mobility and activities will gradually increase. Doctors and Nurses will assist you in:
It is not at all unusual to feel apprehensive about returning home. Sometimes these feelings are prompted by concerns about leaving the security of the hospital, with its expert medical team and equipments. Remember that no patients are allowed to go home until the doctor thinks their condition is satisfactory for them to continue their safe recovery at home.
Depending on your recovery, the senior consultant attending you will organise your discharge. Since you have been through a major operation, the preparation of the discharge summary may take some time as it must be checked and rechecked to ensure that an accurate account of your treatment has been stated. If you feel it needs correction inform the doctor right away.
FATTY FOODS ARE BEST AVOIDED
Cholesterol - Nutrition experts generally agree that keeping blood cholesterol at normal levels reduces the risk of heart complications in persons who have coronary artery disease. It is a good idea to check your blood cholesterol periodically. If it is high you will have to reduce it by proper diet and exercise. If diet and exercise don’t do the job, medications may be needed.
Smoking has a bad effect on the heart, as well as on other parts of the body. It is a major risk factor for additional heart disease after your surgery. If you smoke, quit and if you don’t, don’t start. You may drink alcoholic beverages in moderation only, NEVER exceeding one and a half drink. (60-90 ml of 42% proof whisky or 200 ml. of wine or 375 ml. of Beer)
MEDICATIONS
You should only take medicines which have been prescribed in the discharge summary. Don’t keep taking medicines that you took before the operation unless they are specifically prescribed. Before you leave the hospital make sure you know which medications you must take and what each tablet is for. This is most important. If you are to take anticoagulants you must understand how often follow-up blood tests are to be done.
WHEN SHOULD THE DOCTOR BE CONTACTED ?
Usually, patients are called for follow-up in the OPD by prior appointment. But you can always contact us if there is any problem. Your referring cardiologist will wish to follow your progress, after your visit to the surgeon and in the long term make sure you have appropriate appointments. Call the Doctor on duty if there is any problem (phone numbers have been provided in the booklet and in discharge summary). Call the doctor if there is any sign of infection (redness or drainage at the incision), fever, chills, increased fatigue, shortness of breath, swelling on ankles, weight gain over five pounds (2 kgs) in 5 days, change in heart rate or rhythm or any other sign or symptom that seems disturbing.
For sedentary workers, the average is four to six weeks. For persons who must perform heavy work, the time is six weeks or longer.p>
Routine at Home
Patient Should Follow These Principles
Week 1
Week 2
Week 3
Week 4 & 5
Week 6 & 7