The new face of cardiac surgery in Bangladesh: Safer procedures and smarter care

MICS represents not just a technical evolution but a shift in philosophy towards safer, smarter and more sustainable cardiac care.

Prof Dr. Md Faizus Sazzad  (MBBS, MS, FCPS, FACS, FACC, FRCS, PhD),  Senior Consultant and Coordinator, Department of Cardiothoracic & Vascular Surgery, UNICO Hospitals PLC, Former Cardiac Surgeon and Research Lead, Center of Excellence for Minimally Invasive Cardiac Surgery, National University Health System, National University Hospital, Singapore

Cardiac surgery has transformed over the past few decades from highly invasive procedures to precision-driven, patient-centred care. In Bangladesh, cardiac surgery expanded beyond NICVD from the early 2000s, with private hospitals, public medical colleges and military hospitals increasing the country’s surgical capacity.

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Over the past two decades, Bangladesh has adopted modern practices including off-pump coronary artery bypass (OPCAB), improved cardiopulmonary bypass and myocardial protection, valve surgery, and selected aortic and congenital procedures. Advanced imaging, perioperative monitoring, enhanced recovery protocols and minimally invasive cardiac surgery (MICS) are further moving the field towards safer, more patient-centred care.

However, high patient volumes, late presentation, limited resources and shortages of trained manpower, particularly outside major cities, remain challenges. The priority now is to combine growing surgical capacity with advanced techniques, infrastructure, protocols and quality standards.

What should we adopt?

Coronary artery bypass grafting (CABG): Modern CABG increasingly relies on multidisciplinary Heart Team decisions, using tools such as the SYNTAX score and fractional flow reserve. Greater use of arterial grafts, including internal thoracic and radial arteries, improves long-term outcomes. Minimally invasive CABG, endoscopic vessel harvesting and hybrid CABG can reduce surgical trauma and support personalised treatment.

Heart valve surgery: Advances in echocardiography, prosthetic technology and minimally invasive techniques have made valve treatment increasingly individualised. Valve repair is preferred when feasible, while replacement decisions consider age, anticoagulation, anatomy, thromboembolic risk, pregnancy plans and comorbidities. Techniques such as the Ozaki procedure and minimally invasive valve surgery further expand treatment options.

Arrhythmia surgery: Maze-based surgical ablation for atrial fibrillation can improve rhythm control and reduce stroke risk, but remains largely unavailable in Bangladesh. Limited structured programmes, technology and multidisciplinary collaboration have restricted its adoption.

Heart failure surgery: Surgical ventricular restoration, functional mitral valve interventions and ventricular assist devices remain underdeveloped because of limited infrastructure, high costs and the absence of structured multidisciplinary heart failure programmes.

Aortic surgery: Advanced open and endovascular procedures can treat complex aneurysms and dissections, but Bangladesh has limited access to dedicated aortic programmes, standardised protocols and hybrid operating facilities. Consequently, some patients are referred abroad or remain untreated.

Cardiac surgery is moving towards more precise, patient-centred and minimally invasive care. Among these advances, MICS is particularly transformative, offering smaller incisions, reduced surgical trauma and faster recovery. Its application in valve surgery, hybrid coronary procedures and thoracoscopic arrhythmia treatment represents a shift towards safer, smarter and more sustainable cardiac care.