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FAQ - On Open Heart & Bypass Surgery By Dr. O.P. Yadava
Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi

Dr Yadava completed his medical graduation and Masters in Surgery from Maulana Azad Medical College and had joined Armed Forces as a Surgical Specialist. He cleared his DNB Examination in General Surgery in the year 1983 and completed his training in cardiothoracic surgery at the Cardio Thoracic Center, Armed Forces Medical College, Pune in 1985. For advanced training, went to Australia and worked under and along with some of the greatest cardiac surgeons of recent times. Besides adult cardiac surgery, he was also trained in Paediatric Cardiac Surgery in Melbourne & Japan and successfully cleared the National Boards in Cardiothoracic Surgery (DNBE). He was honoured with Membership of the National Academy of Medical Sciences (MNAMS) in 1994; FICC in 2003, FIACS in 2005 & FCSI in 2012. He has as an experience of over 12,000 open heart surgical procedures and his special field of interest is coronary artery bypass surgery especially total arterial revascularisation & beating heart surgeries (Minimally Invasive).

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about when should we go or not go in for a bypass surgery. Bypass surgery is based on multiple factors such as patients symptoms, the coronary anatomy, the type and degree of the blockage, the financial status whether the patient could afford the surgery and also his psychological state.

In Earlier Times, Bypass Surgery Was Done As An Open Heart Procedure Which Had Lot Of Disadvantages. Owing To The Disadvantages And Whole Body Inflammatory Response, Minimal Invasive Surgery Was Introduced To Avoid The Use Of Heart Lung Machine. Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talks About Minimal Invasive Bypass Surgeries In This Video.
He Describes About Different Forms Of Minimal Invasive Surgeries Used Currently And Which Helps To Avoid Pulmonary Complications, Deep Wound Infections And Also Disadvantages Which Were Caused Due To Open Heart Bypass Surgery.

Bypass Is A Major Surgery And It Has Both Serious As Well Minor Complications. In This Video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, will Talk About The Major And Minor Complication Rates In Bypass Surgery.
The Complication Rates Depend Upon The 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. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talks About Whether Driving Is Safe After A Bypass Surgery. Dr. Yadava also Tells Us About The Adverse Effects If Proper Care Is Not Taken While Driving.
Normally, A Person Can Drive From The Very Next Day Of The Bypass Surgery As There Wont 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.

Bypass Surgery Can Be Performed Multiple Number Of Times. In This Video, Dr. OP. 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 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 Surgery, The Risk Also Goes On Increasing.

In This Video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talks About Total Arterial Bypass Surgery. 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 Arterialrevascularization Known As T Or Y Grafts.

Robotic Bypass Heart Surgeries A Type Of Minimally Invasive Heart Surgery. Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, In This Video Talks About Why Robotic Bypass Surgery Was Introduced.
Robots Were Introduced To Perform Robotic Bypass Surgery With Equal Human Dexterity. Robotic Surgery Has Advantages Over Open Heart Bypass Surgery. Dr. Yadava Talks About Fourth Generation Robots And How Robotic Surgery Is Gaining Attraction. Also, The New Arms Of The Robots Have Received Good Feedbacks And Has Become Feasible In Cardiac Robotic Surgery.

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.

In This Video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Will Tell Us The Criteria Of Total Arterial Bypass Surgery And When It Is Done.
The Results Of Total Arterial Bypass Surgery Are Mostly Superior To The Venous Revascularization. Almost 10 – 15 % Of The Venous Grafts Are Blocked By The End Of One Year. Whereas, The Patency Rates Of Arterial Grafts Is 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. 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.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, 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 the bypass surgery in low ejection fraction. The results of the bypass surgery are not very good if the heart is damaged.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, tells us about the bypass surgery with LV volume reduction. After the bypass surgery, the viable myocardium recovers but 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. OP. 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 transplant. The results of this transplant surgery are improving.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the person who has undergone bypass surgery, as when can he enjoy his married life.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about whether driving is safe after a bypass surgery. Dr. Yadava also tells us about the adverse effects if proper care is not taken while driving.
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. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, tells us about when can a person return to work after a bypass surgery. The patient can start with simple chores at home and get back to their normal desk job within four weeks.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talks about the longevity of bypass surgery. It depends upon the control of risk factors with lifestyle modifications, following the medical treatment properly. It also depends upon how good the surgeon has done his job.
Dr. Yadava discusses that if arterial revascularization has given then the results are for long term and if veins are used then chances of failure are higher. Hence, he tells that control of blood pressure, lipids, control of diabetes status, weight control is very essential. Also the patients should be involved in some physical activities for a long term benefit after bypass surgery.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talks about the arterial graft. He will discuss that with arterial graft, the results are for 20 years. He will explain the positive results with different types of arteries.
The percentage and results of these grafts also depends 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. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talks about the chances of heart attack after bypass surgery during the first year. He will explain that in various studies, it is shown that bypass surgery does not reduce the total incidence of 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 saturates in major arteries as well as microcirculation. Even after bypass surgery, there are certain areas which continues to be ischemic. If the graft has failed, then 3% of patients might get a heart attack within a year.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talks about the results of Bypass Surgery in diabetics. The results are seen in both short term as well long term.
In short term, it is seen that diabetes is a systemic disease and even atherosclerosis. Cholesterol gets deposited in the arteries of the heart, also in the arteries of the brain, kidneys or the 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 high mortality and morbidity.
Dr. Yadava will also talk about long term results in terms of survival and drug patency rates are lower in diabetics as compared to non-diabetics. In such patients, an aggressive treatment is required for glycemic control.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Will discuss whether the bypass surgery can be done along with renal artery stenosis. 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 and then restore the blood supply.
Dr. Yadava will also explain 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, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Will discuss whether bypass can be done along with carotid artery intervention. Bypass surgery can be done with coronary artery intervention which is also called as simultaneous procedure. Dr. Yadava will explain the procedure with different models which are used.
He will also talk about 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 the 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 interbventions is done under same anaesthesia.

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.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, will talk about when to do a non-cardiac surgery after a bypass surgery. 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 a bypass surgery.
Dr. Yadava tells us that the problem arises when the patient has an 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. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Talk about how long to continue dual antiplatelet treatment. The current recommendations for dual antiplatelet therapy is from 6 – 12 months. There are no adequate data available which suggests to continue the dual antiplatelet treatment beyond 12 months. Ideally, after a year one antiplatelet therapy should be stopped and continue with the other antiplatelet for lifelong.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about venous graft. 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 last phase, is the atherosclerosis which happens over one year which 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, will talk about bypass surgery without cutting the sternum. Any surgery in which the sternum is not slit in the center and is approached towards the heart using a small lateral thoracotomy or the anterior thoracotomy is also called as the mid cap operation. These types of surgeries are called sternal sparing minimally invasive surgeries and can be done for single vessel coronary artery disease.