Coronary artery bypass grafting (CABG) is a cardiac surgical procedure designed to restore blood flow to areas of the heart muscle that do not receive an adequate blood supply due to narrowed or blocked coronary arteries. During the procedure, the surgeon takes a healthy blood vessel from another part of the body, such as the chest, arm, or leg, and uses it to create a new pathway (bypass) so that blood can flow around the blocked coronary artery and reach the heart muscle again.
Although the goal of coronary artery bypass surgery is to improve blood flow to the heart, the procedure still carries certain risks, as with any other surgery. Potential risks and complications include bleeding, infection at the chest surgical wound, abnormal heart rhythms or arrhythmias, impaired kidney function, stroke, and temporary problems with memory or thinking ability in some patients. The risks and likelihood of complications may vary from one patient to another, depending on their overall health and individual risk factors.
To help reduce surgical trauma, minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) is now available. Unlike conventional surgery, which requires the breastbone to be divided, MICS CABG is performed through smaller incisions, which may help reduce tissue trauma, bleeding, and pain while supporting a faster recovery. At Mandaya Royal Hospital Puri, MICS CABG is performed by dr. Wirya A. Graha, Sp.BTKV, Subsp. JD(K), with the support of minimally invasive cardiac surgical techniques and technology.
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What Are the Risks of Conventional Coronary Artery Bypass Surgery?
Conventional coronary artery bypass surgery is an open-heart surgical procedure. Like other surgical procedures, it carries a number of potential risks and complications. Some of the risks that may occur after coronary artery bypass surgery include:
- Bleeding.
- Heart attack caused by the formation of blood clots after surgery.
- Infection at the surgical wound in the chest.
- The need for prolonged respiratory support.
- Abnormal heart rhythms (arrhythmias).
- Kidney dysfunction or kidney disease.
- Memory problems or difficulty thinking clearly, which in some cases may be temporary.
- Stroke.
The risk of complications may be higher when coronary artery bypass surgery is performed as an emergency procedure. In addition, each patient’s risk level may vary depending on their health condition before surgery.
Certain medical conditions may increase the risk of complications following coronary artery bypass surgery, including:
- Blocked blood vessels in the legs.
- Chronic obstructive pulmonary disease (COPD).
- Diabetes.
- Kidney disease or impaired kidney function.
To help reduce the risk of complications, doctors may administer medications before surgery, such as medications to help control bleeding and blood pressure and prevent infection. For patients with diabetes, doctors may also provide medication to help control blood glucose levels during the procedure.
Understanding Minimally Invasive Coronary Artery Bypass Surgery (MICS) at Mandaya Royal Hospital Puri
Minimally Invasive Cardiac Surgery Coronary Artery Bypass Grafting (MICS CABG) is a coronary bypass technique performed through smaller access points compared with conventional coronary artery bypass surgery. In this procedure, the surgeon makes an incision approximately 7–10 cm long between the ribs or beneath the left breast, without dividing the breastbone (sternum). Through this access point, the surgeon uses specialized instruments to connect the graft to the coronary artery affected by narrowing or blockage.
MICS CABG can be performed while the heart continues to beat. To help stabilize the area of the heart being operated on, the surgeon may use a stabilizer, allowing the graft connection to be performed in a more controlled manner without significantly interfering with the heart’s function. Because the surgical access is smaller, this technique can reduce tissue trauma and support a faster recovery in suitable patients.
What Are the Benefits of Minimally Invasive Coronary Artery Bypass Surgery?
Compared with conventional coronary artery bypass surgery, MICS CABG uses a less invasive approach with smaller incisions and without dividing the breastbone. This approach may help reduce surgical trauma while supporting the patient’s recovery. Some of the potential benefits of MICS CABG include:
- No need to divide the breastbone (sternum). MICS CABG is performed through an access point between the ribs, so the breastbone does not need to be divided as it is in conventional coronary artery bypass surgery.
- Smaller incision. The procedure is generally performed through an incision of approximately 7–10 cm in the chest area, including beneath the left breast, allowing for a smaller surgical access point and potentially a less noticeable scar.
- Less tissue trauma. The smaller surgical access may help reduce trauma to the tissues and blood vessels surrounding the surgical area.
- Potentially less bleeding. The minimally invasive approach may help reduce bleeding during the procedure, although the amount of bleeding can vary from patient to patient.
- Potentially less postoperative pain. Because the breastbone is not divided, patients may experience less pain and discomfort during recovery.
- May be an option for certain patients. For patients with underlying conditions, such as diabetes or advanced age, a minimally invasive approach may be considered to help reduce surgical trauma. However, eligibility must still be assessed based on each patient’s individual condition.
- The heart continues to beat during the procedure. MICS CABG can be performed while the heart continues to beat, with the assistance of a stabilizer to keep the area of the heart being operated on stable during the graft connection.
Although MICS CABG offers several potential advantages, it is not automatically the right option for every patient. Doctors will consider various factors before determining the appropriate bypass technique, including the condition of the heart, the location and number of blocked coronary arteries, overall health, underlying medical conditions, the complexity of the case, and other medical factors. Based on this assessment, the surgical approach can be tailored to each patient’s individual needs and condition.
Minimally Invasive Coronary Artery Bypass Surgery with Da Vinci Xi Robotic Assistance at Mandaya Royal Hospital Puri
Mandaya Royal Hospital Puri provides minimally invasive coronary artery bypass surgery with the support of the Da Vinci Xi robotic system. In this approach, robotic technology is primarily used to assist the surgeon in harvesting the blood vessel that will be used as the bypass graft, particularly the LIMA (Left Internal Mammary Artery) from the chest wall.
According to dr. Wirya, the use of the Da Vinci Xi provides enhanced visualization and more controlled instrument movement during LIMA harvesting. Some of the potential advantages include:
- A smaller incision may be possible. While the incision for MICS CABG is generally around 8 cm, robotic assistance may allow the incision to be reduced to approximately 5.5 cm, depending on the requirements of the procedure.
- Potentially less pain. A smaller incision may help reduce tissue trauma and potentially minimize discomfort after surgery.
- Supports the recovery process. A smaller surgical wound may support healing and help patients gradually return to their normal activities.
- More controlled LIMA harvesting. The Da Vinci Xi robotic arms provide controlled movement and help the surgeon perform LIMA harvesting with a high degree of precision.
- Helps preserve graft quality. LIMA harvesting is performed carefully to maintain the condition of the blood vessel that will subsequently be used as the bypass graft. LIMA is one of the commonly used grafts in CABG and is known for its long-term durability.
With the support of robotic technology, MICS CABG may be an option for patients who meet the medical criteria for minimally invasive coronary artery bypass surgery.
Read also: First in Indonesia, Mandaya Royal Puri Performs MICS CABG with Da Vinci Xi Robotic Assistance
How Much Does MICS and Robotic Coronary Artery Bypass Surgery Cost at Mandaya Royal Hospital Puri?
The cost of coronary artery bypass surgery may vary from one patient to another. Factors that may affect the cost include the surgical technique used, additional technology involved, the complexity of the patient’s heart condition, and medical care required during hospitalization.
At Mandaya Royal Hospital Puri, both MICS CABG and MICS CABG with robotic assistance are available. The choice of procedure is determined based on the results of the medical examination and the doctor’s evaluation of each patient’s condition.
- MICS coronary artery bypass surgery: starting from IDR 350 million.
- MICS coronary artery bypass surgery with robotic assistance: starting from IDR 499 million.
Note: The prices above are starting prices and may change depending on the patient’s condition, the complexity of the procedure, medical requirements, and the facilities used. For more information about the estimated cost based on your condition, please consult with a doctor first.
Profile and Practice Schedule of dr. Wirya at Mandaya Royal Hospital Puri
dr. Wirya A. Graha, Sp.BTKV, Subsp. JD(K) is a thoracic, cardiac, and vascular surgeon with a subspecialty in adult cardiac surgery at Mandaya Royal Hospital Puri. He performs various cardiac and vascular surgical procedures, including MICS with the support of the Da Vinci Xi robotic system.
dr. Wirya completed his specialist training in Thoracic and Cardiovascular Surgery at the Faculty of Medicine, Universitas Indonesia. He has also continued to develop his expertise in cardiac surgery, including the application of minimally invasive techniques that allow procedures to be performed through smaller surgical access points.
In addition, dr. Wirya is licensed to use the Da Vinci Xi robotic system for robotic coronary artery bypass procedures. This expertise supports the use of robotic technology in MICS CABG, particularly to assist with harvesting the blood vessel that will be used as the bypass graft.
dr. Wirya’s experience in cardiovascular surgery has also been strengthened through his participation in various international conferences and training programs, including:
- 2017: 25th Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery, Seoul, South Korea.
- 2018: 28th Annual Meeting of the Association of Thoracic and Cardiovascular Surgeons of Asia.
- 2019: 1st Joint Biennial South East Asian Regional Congress on Cardiovascular and Thoracic Surgery and 20th MATCVS Annual Scientific Meeting, Malacca.
- 2021: 25th European Vascular Course and 5th European Cardiovascular Course.
Patients who wish to consult about MICS, coronary artery bypass surgery, or other cardiac surgical procedures can consult with dr. Wirya A. Graha at Mandaya Royal Hospital Puri according to the following schedule:
- Tuesday: 4:30–8:00 PM
- Thursday: 4:30–8:00 PM
- Saturday: 10:00 AM–1:00 PM
To make it easier to visit Mandaya Royal Hospital Puri, you can use the Chat via WhatsApp, Book Appointment, or the Care Dokter app, which can be downloaded from Google Play and the App Store. The app allows you to make appointments, check queue numbers, and access other information.
*The information provided on this page is intended for educational purposes and as a general overview. It does not represent the complete range of medical services that may be provided by each doctor. To determine the most appropriate treatment based on your health condition, you are advised to consult directly with the relevant doctor.
If you have any questions, suggestions, or require further information, please contact our call center at 0811-1900-2000.
References:
- Cleveland Clinic. Coronary Artery Bypass Graft (CABG) Surgery. (https://my.clevelandclinic.org/health/treatments/16897-coronary-artery-bypass-surgery). Accessed August 24, 2026.
- Mayo Clinic. Coronary Bypass Surgery. (https://www.mayoclinic.org/tests-procedures/coronary-bypass-surgery/about/pac-20384589). Accessed August 24, 2026.
- Bangkok Hospital. MICS CABG. (https://www.bangkokhospital.com/en/bangkok-heart/content/mics-cabg). Accessed August 24, 2026.