Heart health is one of the most key aspects of overall well-being, and sometimes, conditions like coronary artery disease may require a surgical process to restore usual blood flow to the heart. One common procedure is Heart Bypass Surgery, also known as Coronary Artery Bypass Grafting (CABG). If you’re exploring this treatment option, understanding the Heart Bypass Surgery cost in India is crucial to making informed decisions. This article provides detailed insights into the procedure, its benefits, the recovery process, and a breakdown of the costs involved in India.
India has become a leading destination for heart bypass surgery due to its advanced medical facilities, skilled surgeons, and cost-effective treatment options. Patients from across the globe prefer India not only for affordable healthcare but also for high-quality care, shorter waiting times, and comprehensive post-operative support. Whether you are a domestic patient or traveling from abroad, understanding the cost components and what they include is key to planning your treatment effectively.
In addition to covering the costs and essential details of heart bypass surgery, we will also provide a list of the top 10 hospitals in India for heart bypass surgery. These hospitals are well-known for their state-of-the-art infrastructure, experienced cardiologists, and excellent patient care.
In the sections below, we will discuss what heart bypass surgery entails, the factors that influence its cost in India, and how the country provides exceptional healthcare services at competitive prices. Let’s delve into the details to ensure you’re fully prepared for this life-saving procedure and decide where to seek treatment.
For more detailed information on various surgery costs across India, check out the Comprehensive Guide To Treatment & Surgery Costs In India.
Table of Contents
- Heart Bypass Surgery Cost In India
- Types of Heart Bypass Surgery (CABG) in India
- Cost Of Heart Bypass Surgery (CABG) In Different Indian Cities
- Factors Affecting The Heart Bypass Surgery Cost In India
- Top 10 Heart Bypass Surgery Hospitals In India
- Survival Rate Of Heart Bypass Surgery In India
- Conclusion
- FAQs Related to Heart Bypass Surgery (CABG)
Heart Bypass Surgery Cost In India
1. Average Cost Overview
The average cost of heart bypass surgery in India typically ranges between ₹2,00,000 to ₹7,00,000. This variation depends on factors such as the hospital’s location, type of facility (public or private), surgeon’s expertise, & the complexity of the procedure. India’s affordable yet high-quality healthcare has made it a global hub for heart surgeries.
2. Pre-operative Costs
Before the surgery, several diagnostic and consultation steps are required:
- Consultation Fees:
Patients must consult a cardiologist and cardiac surgeon to assess their condition. Each session may cost ₹800 to ₹3,000, depending on the doctor’s expertise and hospital location. - Diagnostic Tests:
Pre-surgery diagnostics include blood tests, X-rays, Electrocardiograms (ECG), and coronary angiography. The total cost of these tests can range from ₹25,000 to ₹30,000. These tests confirm the patient is fit for surgery & help the surgeon plan the procedure.
3. Hospitalization Costs
- Room Charges:
Hospital room charges vary depending on the type of accommodation chosen:
- General ward: ₹2,000–₹3,000 per day
- Semi-private room: ₹4,000–₹6,000 per day
- Private room: ₹7,000–₹10,000 per day
- A typical hospital stay for CABG surgery lasts 7 to 10 days, including recovery time.
- Intensive Care Unit (ICU):
Patients spend 2 to 3 days in the ICU after surgery for close monitoring. ICU charges are higher, typically ₹5,000 to ₹10,000 per day.
4. Surgery Costs
- Surgeon’s Fees:
The surgeon’s fee forms a significant part of the total cost, ranging from ₹60,000 to ₹2,00,000. Experienced surgeons with specialized training in complex cases command higher fees. - Anesthesia Charges:
Administering anesthesia and monitoring during the surgery costs between ₹15,000 and ₹25,000. - Operating Theatre Charges:
The cost of using the operating theater, including surgical instruments, equipment, and support staff, ranges from ₹10,000 to ₹30,000.
5. Post-operative Care Costs
- Medications:
After surgery, medications such as pain relievers, antibiotics, and anticoagulants are prescribed. These may cost ₹5,000 to ₹15,000. - Physiotherapy and Rehabilitation:
Physiotherapy sessions to aid recovery and improve heart function post-surgery cost ₹1,500 to ₹3,000 per session, depending on the hospital. - Follow-up Visits:
Regular post-surgery check-ups with the cardiologist and surgeon are essential. Each visit typically costs ₹800 to ₹3,000.
6. Miscellaneous Costs
- Dietary Services:
Specialized meals during the hospital stay for patients recovering from heart surgery cost ₹500 to ₹1,500 per day. - Administrative and Support Charges:
These include billing, nursing care, and other administrative fees, amounting to ₹5,000 to ₹10,000.
Types of Heart Bypass Surgery (CABG) in India
Heart bypass surgery, or CABG, is performed to treat coronary artery disease, where the blood flow to the heart is obstructed. The procedure involves using healthy blood vessels from other body parts to reroute blood around blocked arteries. There are several types of CABG, each with its own approach and cost. Let’s break them down in detail:
1. Traditional On-Pump CABG (Conventional CABG)
Overview:
- This is the most common type of CABG. During the procedure, the heart is temporarily stopped, & a heart-lung machine takes over the role of circulating blood & oxygen throughout the body, allowing the surgeon to perform the grafting safely.
Procedure:
- The surgeon makes a large incision down the chest, opens the rib cage, and stops the heart using the heart-lung machine.
- The surgeon then uses healthy blood vessels from the leg, chest, or arm to bypass the blocked arteries.
Cost in India:
- Range: ₹2,00,000 to ₹4,00,000
2. Off-Pump CABG (Beating Heart Surgery)
Overview:
- In this technique, the heart continues to beat during the surgery, and the surgeon uses a stabilizer to hold the affected area in place while bypass grafts are attached.
Procedure:
- The heart is not stopped, which eliminates the need for a heart-lung machine. This approach is generally considered less risky, & it may reduce complications like stroke.
Cost in India:
- Range: ₹3,00,000 to ₹5,00,000
3. Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
Overview:
- This kind of surgery uses smaller incisions and is often used for patients who need only one or two bypasses.
Procedure:
- Instead of opening the chest entirely, small incisions are made between the ribs to access the heart. The heart is still beating, similar to off-pump surgery.
- MIDCAB reduces recovery time and scarring compared to traditional CABG.
Cost in India:
- Range: ₹4,00,000 to ₹6,00,000
4. Robot-Assisted CABG
Overview:
- Robotic surgery uses advanced robotic systems to assist the surgeon with precision during the procedure.
Procedure:
- The surgeon makes tiny incisions, and the robotic system provides enhanced 3D imaging and precision during grafting. This technique may result in quicker recovery, less blood loss, and smaller scars.
Cost in India:
- Range: ₹5,00,000 to ₹7,00,000
5. Redo CABG (Repeat Heart Bypass Surgery)
Overview:
- This surgery is performed for patients who have had previous bypass surgery and now have new blockages or complications with their initial grafts.
Procedure:
- Redo CABG is more complex than the initial surgery because the surgeon has to work around existing grafts and scar tissue.
Cost in India:
- Range: ₹5,00,000 to ₹8,00,000
Cost Comparison Table for Heart Bypass Surgery (CABG) in India
Type of CABG | Approximate Cost (INR) | Procedure Overview |
Traditional On-Pump CABG | ₹2,00,000 to ₹4,00,000 | Conventional method, the heart-lung machine used |
Off-Pump CABG | ₹3,00,000 to ₹5,00,000 | Pounding heart surgery, the heart remains active during the procedure |
Minimally Invasive CABG (MIDCAB) | ₹4,00,000 to ₹6,00,000 | Small incisions, less recovery time, suitable for 1-2 arteries |
Robot-Assisted CABG | ₹5,00,000 to ₹7,00,000 | Robotic precision, smaller incisions, faster recovery |
Redo CABG | ₹5,00,000 to ₹8,00,000 | For patients with previous bypass surgeries |
Cost Of Heart Bypass Surgery (CABG) In Different Indian Cities
1. Mumbai
As one of the country’s largest metropolitan cities, Mumbai has numerous top-tier hospitals offering advanced healthcare services. The cost of heart bypass surgery in Mumbai can vary widely based on the hospital’s reputation, facilities, and the surgeon’s experience.
- Estimated Cost: ₹1,20,000 to ₹4,40,000
- Factors Affecting Cost:
- Top Hospitals: Leading hospitals like Kokilaben Dhirubhai Ambani Hospital, Jaslok Hospital, and Lilavati Hospital often have higher charges, especially for advanced procedures like robotic-assisted surgeries.
- Complexity of the Procedure: Whether it’s a simple bypass with a single graft or a more complex procedure with multiple grafts.
- Pre-and Post-operative Care: Hospitals with state-of-the-art ICU facilities and personalized care post-surgery might charge more.
- Surgeon’s Experience: Renowned cardiac surgeons may charge a premium for their expertise.
2. Delhi
Delhi is home to many reputed public and private hospitals known for providing world-class heart surgery treatments. The capital city attracts patients nationwide due to its advanced healthcare systems.
- Estimated Cost: ₹1,80,000 to ₹3,60,000
- Factors Affecting Cost:
- Renowned Hospitals: Hospitals such as All India Institute of Medical Sciences (AIIMS), Fortis Escorts Heart Institute, and Max Super Specialty offer high-quality services, but the costs can vary depending on the hospital.
- Treatment Type: Costs may increase if additional services such as robotic-assisted surgeries or minimally invasive techniques are used.
- Insurance Coverage: Some hospitals provide packages with health insurance, reducing out-of-pocket costs for patients.
3. Bangalore
Bangalore has rapidly become a hub for medical tourism, particularly for heart surgeries. The city offers high-quality services at competitive rates.
- Estimated Cost: ₹2,10,000 to ₹3,60,000
- Factors Influencing The Cost:
- Leading Hospitals: Manipal Hospital, BGS Global Hospital, and Sakra Premium Clinic are prominent in offering affordable yet high-standard treatments.
- Procedure Type: Traditional on-pump surgeries tend to be cheaper compared to robotic-assisted or off-pump surgeries, which involve advanced technology and higher costs.
4. Chennai
Chennai is one of India’s most important healthcare destinations for heart surgeries. The city has several specialized heart centers with advanced medical technology.
- Estimated Cost: ₹2,25,000 to ₹3,75,000
- Factors Affecting Cost:
- Renowned Cardiac Institutes: Sri Ramachandra Medical Centre, Fortis Malar Hospital, and Kaveri Hospital are among the best in Chennai, offering affordable treatment options.
- Medical Infrastructure: Chennai’s advanced infrastructure, especially in heart care, ensures quality care, but patients can still find competitive prices compared to other metro cities.
- International Patients: Chennai also attracts international patients, which may affect pricing, as foreign patients may require specialized care.
5. Hyderabad
Hyderabad has become one of the most well-known centers for advanced medical care, especially in cardiology. The city is known for both its state-of-the-art hospitals and experienced cardiac specialists.
- Estimated Cost: ₹2,50,000 to ₹4,00,000
- Factors Affecting Cost:
- Top Hospitals: Some well-known hospitals like Care Hospital, KIMS, and Global Hospitals provide cost-effective heart surgery services.
- Technology & Specialization: The adoption of robotic-assisted and off-pump surgeries makes the cost fluctuate, as these procedures may be priced higher due to their state-of-the-art technology and expertise required.
6. Kolkata
Kolkata is home to several experienced cardiac surgeons and healthcare centers, making it an attractive option for heart surgeries. The city’s hospitals are known for offering quality services at relatively lower costs than other metro cities.
- Estimated Cost: ₹2,75,000 to ₹4,25,000
- Factors Affecting Cost:
- Leading Hospitals: Institutions such as Peerless Hospital, AMRI Hospitals, and Medica Superspecialty provide excellent heart care services.
- Procedure Complexity: Similar to other cities, the cost increases based on the complexity of the surgery, like the use of advanced technology or multiple grafts.
Cost Comparison Table:
City | Estimated Cost (INR) |
Mumbai | ₹1,20,000 – ₹4,40,000 |
Delhi | ₹1,80,000 – ₹3,60,000 |
Bangalore | ₹2,10,000 – ₹3,60,000 |
Chennai | ₹2,25,000 – ₹3,75,000 |
Hyderabad | ₹2,50,000 – ₹4,00,000 |
Kolkata | ₹2,75,000 – ₹4,25,000 |
For an in-depth look at treatment and surgery costs across Indian cities, refer to the Comprehensive Guide To Treatment & Surgery Costs In India.
Factors Affecting The Heart Bypass Surgery Cost In India
Several factors can influence the cost of heart bypass surgery in India. Here are some factors that can affect the final cost:
1. Hospital and Location: The choice of hospital and its location can significantly impact the cost of heart bypass surgery. Premier hospitals in major metropolitan cities tend to have higher costs than smaller hospitals in less urban areas.
2. Surgeon’s Fee: The experience and reputation of the cardiac surgeon performing the procedure can affect the cost. Highly skilled and renowned surgeons may charge higher fees for their services.
3. Type of Bypass Surgery: The cost can vary depending on the type of bypass surgery required. Common types include on-pump (traditional) bypass surgery, off-pump (beating heart) bypass surgery, and minimally invasive bypass surgery. Minimally invasive techniques often have higher costs due to the use of specialized equipment and technology.
4. Preoperative Tests: Before the surgery, various diagnostic tests are performed to assess the patient’s overall health and determine the specific requirements of the surgery. These tests, such as blood tests, electrocardiograms (ECG), echocardiograms, and angiograms, can contribute to the overall cost.
5. Hospital Stay: The duration of hospitalization following the surgery can influence the cost. The heart bypass surgery cost includes the charges for the room, nursing care, medication, and other ancillary services.
6. Intensive Care Unit (ICU) Charges: If the patient requires post-operative care in the ICU, it will add to the overall heart bypass surgery cost. ICU charges include specialized equipment, continuous monitoring, and critical care services.
7. Medications and Consumables: The cost of medications, including anesthesia, pain relief, antibiotics, and other necessary drugs, can contribute to the total expense. The cost of consumables such as surgical instruments, graft materials, and disposables also adds to the overall cost.
8. Other Medical Services: Additional medical services such as consultations with specialists, physiotherapy, cardiac rehabilitation, and follow-up visits contribute to the total cost. These services may vary based on individual patient needs and hospital policies.
9. Insurance Coverage: The extent of insurance coverage or health insurance policies can have an impact on out-of-pocket expenses for the patient. It is essential to review insurance policies and understand coverage limitations, deductibles, and copayments.
It is worth noting that the cost of heart bypass surgery can vary widely depending on the factors mentioned above. It is recommended to consult with healthcare providers and hospitals to get accurate cost estimates tailored to specific medical requirements.
Top 10 Heart Bypass Surgery Hospitals In India
India has become a popular destination for medical tourism due to its advanced healthcare infrastructure, skilled medical professionals, and cost-effective treatment options. With numerous hospitals specializing in heart bypass surgery, this article highlights the top 10 heart bypass surgery hospitals in India.
These hospitals are renowned for their state-of-the-art facilities, experienced cardiac surgeons, high success rates, and excellent patient care. Patients from across the globe seek treatment at these hospitals, benefiting from cutting-edge technology, personalized treatment plans, and comprehensive post-operative care. The hospitals listed below have consistently demonstrated their expertise in heart bypass surgeries, making them the preferred choices for domestic and international patients.
Now, we will look at the 10 best Heart Bypass Surgery Hospitals in India:
1) Indraprastha Apollo Hospitals

- Established: 1996
- History:
- A flagship hospital of the Apollo Group, Indraprastha Apollo is one of India’s first hospitals to be accredited by Joint Commission International (JCI).
- Known for pioneering advanced cardiac treatments and surgeries.
- Key Achievements:
- Performed India’s first heart transplant in the private sector in 1995.
- Offers a 98% success rate for cardiac bypass surgeries, with over 1,00,000 successful procedures to date.
- Advanced robotic-assisted CABG surgeries for faster recovery and minimal scarring.
- Special Features:
- Dedicated cardiac unit with advanced imaging technologies like 64-slice CT scanners and hybrid operating rooms.
- Location: Sarita Vihar, New Delhi
2) Artemis Hospital

- Established: 2007
- History:
- Founded by the Apollo Tyres Group promoters, Artemis Hospital is a leader in adopting cutting-edge technology and offering patient-centered care.
- Key Achievements:
- First hospital in Gurgaon to receive JCI accreditation.
- Known for minimally invasive cardiac surgeries with faster recovery and reduced risk.
- Offers specialized cardiac rehab programs post-surgery to improve patient outcomes.
- Special Features:
- State-of-the-art operation theatres with advanced cardiac monitoring systems.
- Location: Gurgaon, Haryana
3) Medanta The Medicity

- Established: 2009
- History:
- Founded by Dr. Naresh Trehan, a globally renowned cardiac surgeon, Medanta was established as a multi-specialty healthcare destination with a strong focus on cardiac care.
- Key Achievements:
- First hospital in India to introduce robotic surgeries for cardiac cases.
- Successfully completed over 50,000 cardiac surgeries since inception.
- Recognized for treating complex cardiac cases referred from across the globe.
- Special Features:
- Home to a dedicated Heart Institute with specialized programs for advanced heart failure, minimally invasive CABG, and valve repair.
- Location: Gurgaon, Haryana
4) BLK Super Speciality Hospital

- Established: 1959
- History:
- Inaugurated by Pt. Jawaharlal Nehru, BLK-Max has grown from a 200-bed facility to a modern super-specialty hospital.
- Key Achievements:
- Recognized for performing high-risk CABG surgeries and heart transplants.
- One of the first hospitals in India to offer Extracorporeal Membrane Oxygenation (ECMO) for heart failure patients.
- Special Features:
- Advanced heart failure clinic and comprehensive rehabilitation services.
- Location: Pusa Road, New Delhi
5) Aster Medcity

- Established: 2014
- History:
- Aster Medcity is part of Aster DM Healthcare, which manages a network of hospitals across India and the Middle East.
- Key Achievements:
- Offers cutting-edge robotic-assisted cardiac surgeries.
- Awarded the Best Cardiology Hospital in Kerala by Times Health Survey.
- Special Features:
- A fully integrated cardiac sciences department focusing on minimally invasive surgeries and patient rehabilitation.
- Location: Kochi, Kerala
6) Apollo Hospital Chennai

- Established: 1983
- History:
- The first hospital in the Apollo Group, this institution redefined healthcare in India by introducing private-sector multi-specialty hospitals.
- Key Achievements:
- First Indian hospital to perform a successful pediatric heart transplant.
- Over 1,52,000 cardiac surgeries were performed, including complex cases.
- Special Features:
- Offers advanced imaging, robotic surgeries, and a dedicated cardiac ICU.
- Location: Greams Road, Chennai
7) Kokilaben Dhirubhai Ambani Hospital

- Established: 2009
- History:
- This hospital is part of the Reliance Group and was built to provide high-quality healthcare with cutting-edge technology.
- Key Achievements:
- Over 6,000 successful CABG surgeries were performed with excellent outcomes.
- It is the only hospital in Mumbai with a full-time specialist system (FTSS) for better patient care.
- Special Features:
- Dedicated hybrid cath labs and advanced cardiac imaging facilities.
- Location: Andheri West, Mumbai
8) Fortis Escorts Heart Institute

- Established: 1988
- History:
- One of India’s oldest dedicated cardiac hospitals, known for its consistent innovation in heart care.
- Key Achievements:
- Treated over 200,000 heart patients since its inception.
- A leader in pediatric cardiac care with a dedicated unit for children.
- Special Features:
- Advanced imaging systems like 3D echocardiography and intravascular ultrasound.
- Location: Okhla Road, New Delhi
9) Asian Heart Institute

- Established: 2002
- History:
- Dr. Ramakanta Panda founded this hospital specializing in cardiac care and has achieved global recognition for its high success rates.
- Key Achievements:
- 99.83% success rate in CABG surgeries.
- Ranked among the best heart hospitals in Asia by international medical surveys.
- Special Features:
- Focus on precision surgery using advanced robotic systems.
- Location: Bandra-Kurla Complex, Mumbai
10) All India Institute of Medical Sciences- (AIIMS)

- Established: 1956
- History:
- AIIMS is a government-funded institution that serves as a center for excellence in healthcare, education, and research.
- Key Achievements:
- One of India’s largest cardiothoracic centers, performing over 1,000 CABG surgeries annually.
- A leader in cardiac research, contributing to innovations in minimally invasive procedures.
- Special Features:
- Affordable yet world-class cardiac care services.
- Location: Ansari Nagar, New Delhi
Survival Rate Of Heart Bypass Surgery In India
The survival rate for CABG can vary based on factors like the patient’s age, overall health, the presence of other diseases (comorbidities), and the specific hospital and surgeon’s experience and skills.
A study published in the Indian Heart Journal 2016 reported an in-hospital mortality rate of 2.1% for isolated CABG. This means that about 97.9% of patients survived the immediate hospital stay following the surgery. Long-term survival rates can also be relatively high, with some studies reporting that about 90% of patients survive more than 3 years post-surgery.
According to another study, the survival rate for patients who undergo heart bypass surgery and make it through the first month after the operation is close to that of the general population. This indicates that the procedure has a high success rate in improving the long-term survival of patients.
Survival Rate By Age
The survival rate for CABG is quite high. A medical study published in the Journal of the American Medical Association in 2019 claims that the survival rate for CABG patients was around 96% at 30 days post-surgery and about 93.5% at 1 year post-surgery.
However, age can significantly impact these rates. Older patients, particularly those over 80, may have lower survival rates due to increased risk of complications and other health conditions. It’s also important to note that these rates vary by country and specific healthcare system.
Conclusion
In conclusion, heart bypass surgery (CABG) is an essential procedure for those with severe heart conditions, and India offers a variety of options for patients seeking treatment. The surgery cost can vary based on factors like the hospital, location, type of surgery, and the patient’s specific needs. However, compared to many Western countries, the cost of heart bypass surgery in India is relatively inexpensive, making it an attractive destination for medical tourism. Patients must research and choose the right healthcare provider to ensure the best care and outcome. Overall, CABG surgery in India offers quality treatment at a more accessible price, helping people recover and improve their heart health.
High costs often create barriers for individuals in need of life-saving heart bypass surgery in India. However, a fundraising platform can play a key role in bridging the financial gap & providing much-needed support. The power of social media and online connectivity allows fundraising campaigns to reach a vast audience. By leveraging various digital platforms, the fundraising campaign can garner attention, empathy, and donations from a global community of compassionate individuals, increasing the chances of meeting the required funds.
FAQs Related to Heart Bypass Surgery (CABG)
What Is Heart Bypass Surgery?
Heart bypass surgery is a surgical method that enhances blood flow to the heart. Surgeons use a healthy blood vessel, usually taken from the leg, arm, or chest, to create a new path around blocked or narrowed coronary arteries, restoring oxygen-rich blood to the heart.
What Is CABG?
Coronary Artery Bypass Grafting (CABG) is a surgical technique used to treat advanced coronary artery disease (CAD) by enhancing blood flow to the heart. It is performed when coronary arteries are blocked or narrowed, limiting blood supply to the heart muscle.
What Is CABG in Medical Terms?
In medical terms, CABG refers to a procedure where surgeons “graft” a healthy blood vessel onto a coronary artery to bypass the blocked segment, ensuring proper blood flow. It is one of the most common and effective treatments for coronary artery disease.
Is Open Heart Surgery and Bypass Surgery the Same?
No, open heart surgery and bypass surgery are not exactly the same. Open heart surgery is a broad term that refers to any procedure where the chest is opened and the heart is operated on. Bypass surgery (CABG) is a specific type of open heart surgery focused on bypassing blocked coronary arteries.
How Do They Do Heart Bypass Surgery?
Heart bypass surgery involves several steps:
- Preparation: The patient is put under general anesthesia.
- Incision: A doctor makes an incision in the chest and exposes the heart.
- Blood Vessel Harvesting: Healthy blood vessels are taken from the leg, arm, or chest.
- Grafting: The surgeon attaches the healthy blood vessels to bypass blocked arteries.
- Closure: The chest is closed, and the patient is moved to recovery.
How Much Does Heart Bypass Surgery Cost?
The cost of heart bypass surgery varies widely depending on the country, hospital, and patient condition. In the United States, it typically ranges from $30,000 to $150,000. In countries like India, the cost is significantly lower, averaging between $5,000 and $10,000.
What Happens After Heart Bypass Surgery?
After heart bypass surgery:
- Hospital Recovery: Patients typically spend 5-7 days in the hospital, with 1-2 days in the ICU.
- Rehabilitation: Cardiac rehabilitation helps patients recover strength and improve heart health.
- Lifestyle Changes: Doctors advise a healthy diet, regular exercise, and quitting smoking.
- Medication: Medications are prescribed to prevent blood clots, lower cholesterol, and manage blood pressure. Most patients return to normal activities within 6-12 weeks, but full recovery may take longer.