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In standard (on-pump) CABG, the heart is stopped and blood is circulated by a bypass machine. While effective, this carries a risk of systemic inflammation, stroke, kidney injury, and neurocognitive changes — the so-called "pump syndrome." Off-pump CABG (OPCAB) eliminates this by grafting the coronary arteries while the heart continues to beat, using stabiliser devices to immobilise a small area around the target vessel.
The benefits for appropriately selected patients include: reduced risk of stroke, lower blood transfusion requirement, earlier extubation, shorter ICU stay, faster discharge, and fewer systemic complications — particularly important for diabetic, elderly, and renally impaired patients.
Off-Pump CABG (OPCAB) On-Pump CABG (when anatomically indicated)Mitral regurgitation is the most common valve problem requiring surgery. In this condition, the valve leaks blood backwards into the lungs with each heartbeat, causing progressive breathlessness, fatigue, and left ventricular dilation. Left untreated, it leads to irreversible heart failure.
Dr. Agarwal strongly prefers mitral valve repair over replacement wherever anatomically feasible. Repair preserves the native valve, maintains better left ventricular geometry, eliminates the need for lifelong anticoagulation, and is associated with superior long-term outcomes. Repair techniques include ring annuloplasty, leaflet resection, chordal transfer, and chord replacement with neochords.
When repair is not feasible due to rheumatic disease or extensive leaflet damage, replacement with a bioprosthetic (tissue) or mechanical valve is performed. Mechanical valves are preferred in younger patients (who can take long-term anticoagulation); tissue valves for patients over 65 or those who cannot tolerate anticoagulation.
Mitral Valve Repair (Ring + Leaflet) Mitral Valve Replacement — Tissue / MechanicalAortic stenosis — typically from age-related calcification or bicuspid aortic valve — causes progressive exertional breathlessness, syncope, and chest pain. Without surgery, survival after symptom onset can be as short as 2–5 years. Aortic regurgitation causes gradual left ventricular dilation; by the time symptoms develop, the ventricle may already be significantly impaired.
Dr. Agarwal performs aortic valve replacement (AVR) with either a bioprosthetic tissue valve (no anticoagulation needed beyond 3 months) or a mechanical prosthesis (requires lifelong warfarin). The choice depends on age, lifestyle, comorbidities, and patient preference — a decision made collaboratively with the patient in clinic.
Aortic Valve Replacement — Tissue / MechanicalRheumatic heart disease — still prevalent in North India — can damage multiple valves simultaneously. Combined mitral and aortic valve replacement is a higher-complexity procedure requiring precise myocardial protection and sequential implantation. Dr. Agarwal has extensive experience in double valve replacement with optimal long-term outcomes at Charak Hospital.
Combined MVR + AVRThe Bentall Procedure is indicated when both the aortic valve and the aortic root are diseased — as seen in Marfan Syndrome, bicuspid aortic valve with root dilation, or aortic root aneurysm. The procedure replaces the entire aortic root and valve as a composite graft, with careful reimplantation of both coronary arteries. It is one of the most technically demanding procedures in adult cardiac surgery.
Dr. Agarwal performs the Bentall Procedure using composite mechanical or biological valved conduits. A valve-sparing root replacement (David Procedure) is considered in select younger patients with preserved valve leaflets.
Bentall Procedure David Procedure (Valve-Sparing Root)A thoracic aortic aneurysm is a silent killer — it causes no symptoms until it dissects or ruptures. Surgical repair involves replacing the dilated aortic segment with a Dacron graft. Timing of elective repair is guided by aortic diameter, rate of growth, family history, and underlying connective tissue disorder. Emergency surgery is required for acute Type A aortic dissection — one of cardiothoracic surgery's most time-critical emergencies.
Thoracic Aortic Graft Replacement Emergency Type A Dissection RepairAdult heart transplantation is the definitive treatment for end-stage dilated cardiomyopathy, ischaemic cardiomyopathy, and failed valve surgery with ventricular failure. Charak Hospital's transplant programme includes pre-transplant workup, waitlist management, organ procurement, transplant surgery, and post-transplant immunosuppression management.
Orthotopic Heart Transplantation| Procedure | Duration | Hospital Stay | Approx. Cost (INR) |
|---|---|---|---|
| CABG — Off-Pump | 3–5 hrs | 7–10 days | ₹2,00,000 – ₹4,50,000 |
| Mitral Valve Repair | 3–4 hrs | 7–10 days | ₹2,00,000 – ₹3,50,000 |
| Mitral / Aortic Valve Replacement | 3–4 hrs | 7–10 days | ₹2,50,000 – ₹4,00,000 |
| Double Valve Replacement | 4–6 hrs | 8–12 days | ₹3,50,000 – ₹5,50,000 |
| Bentall Procedure | 5–7 hrs | 10–14 days | ₹4,00,000 – ₹7,00,000 |
| Thoracic Aortic Repair | 5–8 hrs | 10–14 days | Contact for personalised estimate |
*Indicative costs. Actual costs depend on valve type, implant, ICU duration, and patient condition. Ayushman Bharat, CGHS, ECHS, and private insurance accepted.