Dr Ramakant Panda, one of the leading cardiothoracic surgeons of India, informs us that patients try to delay the second bypass as much as possible. ``There really is no reason to be afraid. Re-operative surgery is quite common now,'' he says.

But first things first. What does a bypass involve? ``Say, one of the three arteries that control blood flow to and from the heart develops a block. Surgery cures this by literally `bypassing' the block and creating an alternate passage for the blood to flow. Like a traffic diversion. A vein from the leg, or anartery from the hand or chest is grafted to create this alternate route,'' he informs.

Until a few years ago, Indians preferred to undergo a bypass abroad. ``This trend was seen until 1984-85, but since then things have changed. The bypass technique has been perfected in our country now, and the mortality rate is a mere 1-2 per cent,'' explains Panda. ``State-of-the-art facilities are available at the All India Institute of Medical Sciences (AIIMS) and the Escorts Heart Institute in New Delhi, at the Apollo Hospital in Chennai, and at the leading hospitals of Mumbai, which include Jaslok, Nanavati and Bombay Hospital,'' he adds.

But the risk is not over once the bypass is through. ``Two risk factors can crop up after the first bypass: either a block develops at another point in the artery, or the vein which has been grafted gets blocked. This takes about 10 or 15 years, depending upon the lifestyle of the person,'' says the doctor. Does that implying that the risk factors are within the patient's control?``Certainly!'' says Panda. ``The only thing one cannot change is a family history of the disease. But one can avoid smoking (it is by far the biggest reason why most people suffer from heart diseases), curb the intake of cholesterol, and exercise regularly.'' Of course, this is easier said than done.

Is the second operation any different from the first? ``It is more intricate. The heart is enveloped by a thin membrane which conceals a protective fluid. Once the first bypass is performed the membrane flattens, and the heart gets stuck behind the breastbone. So a re-operative surgery involves spending an hour or two just to carefully identify and reach the affected artery, and then the block,'' says Dr Panda. ``The first bypass does not take more than a few minutes to complete.''

He adds, ``Most patients are fearful of undergoing re-operative bypass, and try to delay it as far as they can with the help of certain drugs. You see, the bypass technique is only around 30 years old. The first surgery in Indiawas performed around 1975. And second bypass is only being done here since the last 5-7 years. Still, the last two years have seen a lot of development in technique, and as they realise this, people are getting over their fears.'' It's heartening to hear that.