Kickstarting the First Coronary Artery Bypass Graft Program in Papua New Guinea-History Made, Yet a Long Journey...

Background/Objectives: Papua New Guinea has a population of over 10 million, with its public cardiac surgical service provided by only one tertiary center. Despite the climbing burden of ischemic heart disease, no CABG operation has been performed before 2025 due to limited local surgical capacity. An international collaboration was planned in order to launch a CABG program in the country. Methods: Three cases were shortlisted after a multidisciplinary team discussion. A team-based "On-the-job" mentoring strategy was employed to facilitate skill transfer. The operation was carried out in a "twinning" fashion, with each role of the surgical team being taken up by "a pair"-the trainer (visiting team) and the learner (local team). The trainer demonstrated key skills and tips in the first case, and the "pair" switched positions in the following cases to maximize hands-on learning. The last case was performed entirely by the local team. Results: Three patients underwent CABG operations in this pilot program. A total of 2.33 grafts/case were performed on average, with no 30-day mortality. There were no major complications except for one patient developing right middle cerebral artery infarct on postoperative day 5. The patient was discharged one month later after achieving functional recovery and was started on anticoagulation therapy. Conclusions: International collaborations with strategic planning can play a critical role in starting new cardiac surgical programs in low-middle-income countries, with acceptable surgical outcomes. History has been made with the first-ever CABG operation successfully performed in Papua New Guinea. The journey ahead to sustain local cardiac surgical capacity and to provide safe and accessible cardiac surgical care for the country remains challenging.