{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:47:36Z","timestamp":1782452856734,"version":"3.54.5"},"reference-count":13,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u201cOn-the-job\u201d mentoring strategy was employed to facilitate skill transfer. The operation was carried out in a \u201ctwinning\u201d fashion, with each role of the surgical team being taken up by \u201ca pair\u201d\u2014the trainer (visiting team) and the learner (local team). The trainer demonstrated key skills and tips in the first case, and the \u201cpair\u201d 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\u2013middle-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.<\/jats:p>","DOI":"10.3390\/jcm15124763","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:04:04Z","timestamp":1781874244000},"page":"4763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Kickstarting the First Coronary Artery Bypass Graft Program in Papua New Guinea\u2014History Made, Yet a Long Journey Ahead"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9316-6153","authenticated-orcid":false,"given":"Ling","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim Chai","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daobo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kanasa","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Port Moresby General Hospital, Boroko 111, National Capital District, Port Moresby 111, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7936-3642","authenticated-orcid":false,"given":"Arvin Wesley","family":"Karu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Port Moresby General Hospital, Boroko 111, National Capital District, Port Moresby 111, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Block 2 Level 2 Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Tapaua","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Port Moresby General Hospital, Boroko 111, National Capital District, Port Moresby 111, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0963-3402","authenticated-orcid":false,"given":"Yeow Leng","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref_1","first-page":"134","article-title":"Outcomes of Complex Rheumatic Valvular Heart Surgery in Papua New Guinea. A Case Series Analysis","volume":"6","author":"Kawa","year":"2024","journal-title":"J. Cardiol. Cardiovasc. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"ezae355","DOI":"10.1093\/ejcts\/ezae355","article-title":"2024 EACTS Guidelines on perioperative medication in adult cardiac surgery","volume":"67","author":"Jeppsson","year":"2025","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.athoracsur.2020.05.150","article-title":"Cardiac Surgery and Small Island States: A Bridge Too Far?","volume":"111","author":"Vervoort","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e037991","DOI":"10.1161\/JAHA.124.037991","article-title":"Global, Regional, and National Burden of Valvular Heart Disease, 1990 to 2021","volume":"13","author":"Chen","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1016\/j.jacc.2023.11.007","article-title":"Global Burden of Cardiovascular Diseases and Risks, 1990\u20132022","volume":"82","author":"Mensah","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.gheart.2018.08.002","article-title":"Global Unmet Needs in Cardiac Surgery","volume":"13","author":"Zilla","year":"2018","journal-title":"Glob. Heart"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.hlc.2007.05.013","article-title":"Operation Open Heart in PNG, 1993\u20132006","volume":"16","author":"Tefuarani","year":"2007","journal-title":"Heart Lung Circ."},{"key":"ref_8","unstructured":"(2026, May 04). World Health Organization Data\u2014Papua New Guinea. Available online: https:\/\/data.who.int\/countries\/598."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.atssr.2023.11.019","article-title":"Global Cardiac Surgical Volume and Gaps: Trends, Targets, and Way Forward","volume":"2","author":"Vervoort","year":"2024","journal-title":"Ann. Thorac. Surg. Short Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.xjon.2024.03.005","article-title":"Cardiothoracic surgery training in Africa: History and developments","volume":"19","author":"Effiom","year":"2024","journal-title":"JTCVS Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.1111\/jocs.14965","article-title":"Developing a cardiac surgery unit in the Caribbean: A reflection","volume":"35","author":"Angelini","year":"2020","journal-title":"J. Card. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.jtcvs.2019.04.039","article-title":"Global cardiac surgery: Access to cardiac surgical care around the world","volume":"159","author":"Vervoort","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/ejcts\/ezy272","article-title":"The Cape Town declaration on access to cardiac surgery in the developing world","volume":"54","author":"Zilla","year":"2018","journal-title":"Eur. J. Cardiothorac. 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