Advances in cardiac surgery mean that some patients can now undergo coronary artery bypass graft (CABG) through smaller chest incisions
The latest national mortality statistics (2024) by the Department of Statistics Malaysia show that ischaemic heart disease due to coronary artery disease (CAD) remains the leading cause of death in Malaysia.
Treatment for the condition ranges from lifestyle changes and medications to angioplasty and stenting or coronary artery bypass graft (CABG) surgery, depending on the severity and complexity of the disease.
According to Sunway Medical Centre Velocity (SMCV) consultant cardiothoracic surgeon Dr Mohd Zamrin Dimon, “Treatment is individualised. Cardiologists and cardiothoracic surgeons consider whether medication, angioplasty and stenting, CABG or a combination of approaches is likely to provide the safest and most effective result.”
First, a definitive diagnosis requires several tests, of which coronary angiography plays a pivotal role in determining the extent and location of coronary artery disease, notes Dr Mohd Zamrin.
Once the affected coronary arteries have been identified, doctors will assess factors such as the patient's age, heart function, kidney and lung function, other medical conditions, and overall fitness before recommending a suitable treatment.
“CABG is more likely to be considered when coronary artery disease is extensive or complex, especially when several major heart arteries are affected, an important artery supplying a large area of the heart is severely narrowed or blocked, or an artery has been completely blocked for a long time (chronic total occlusion or CTO). The location of the narrowing is also important, and patients who experience recurrent stenosis are more likely to be considered for CABG,” explains Dr Mohd Zamrin.
Traditionally, CABG is performed through a median sternotomy, where an incision is made along the centre of the chest and the breastbone is divided for access. It is a major operation and, like any surgery, carries risks. Possible complications include bleeding, infection, abnormal heart rhythms, heart attack, stroke and kidney problems.
However, advances in surgical techniques have made a less invasive approach possible. Minimally invasive coronary artery bypass grafting (MIS CABG) allows surgeons to perform the surgery through a smaller opening in the chest.
Depending on the technique, the heart may be accessed through an incision at the front or side of the chest, often between the ribs. The operation may also be performed either with the support of a heart-lung machine (on-pump) or on the beating heart without cardiopulmonary bypass (off-pump), informs Dr Mohd Zamrin.
For suitable patients, the smaller incision may mean a small scar, less surgical trauma and potentially less postoperative discomfort, fast healing and an early return to normal activities.
It may also reduce some of the recovery considerations associated with dividing and healing of the breastbone. Patients usually have a short hospital stay and return to their usual activities sooner, notes Dr Mohd Zamrin.
As not all patients are suited for MIS CABG, patient selection is important. The surgeon needs to consider how many coronary arteries require bypasses, where the blockages are located, the patient's coronary anatomy, heart function, previous surgery and other health conditions. “Certain complex patterns of coronary artery disease may be more safely or effectively treated using conventional CABG,” explains Dr Mohd Zamrin.
The important question is not, "Can my operation be done through a smaller incision?" but "Which treatment will give me the safest and most effective result?"
Not every blocked coronary artery requires bypass surgery. But when CABG is needed, advancement such as MIS CABG provide another surgical option for eligible patients.
“Whether the answer is medication, stenting, conventional CABG or MIS CABG, the goal remains the same: to choose the right treatment for the right patient and restore adequate blood flow to the heart as safely and effectively as possible, with the least amount of pain,” emphasises Dr Mohd Zamrin.
KKLIU 3685 / EXP 31.12.2028
For more info on MIS CABG, visit:
Sunway Medical Centre Velocity,
Lingkaran SV2, Sunway Velocity,
55100 Kuala Lumpur.
