Surgeons at Aster Hospital, Al Qusais, in Dubai have performed a five-vessel coronary artery bypass graft (CABG x5) procedure involving 11 arterial anastomoses, carried out entirely on a beating heart without cross-clamping or manipulating the aorta. The eight-hour operation, described by the treating team as one of the most technically demanding bypass procedures undertaken at the facility, was performed on a 55-year-old Indian resident of the UAE.
Clinical presentation and diagnosis
The patient, Santokh Singh Ajit Singh, presented with chest pain radiating to both shoulders that had persisted for almost six days. A coronary angiogram carried out on 25 May 2026 identified severe multivessel blockages. Subsequent evaluation confirmed advanced coronary artery disease with angina, alongside hyperlipidemia, a recognised contributory risk factor. Cardiovascular disease remains the leading cause of death worldwide, accounting for an estimated 17.9 million deaths annually and close to 32% of global mortality, while in the UAE heart attacks and strokes are linked to approximately 41% of deaths.
Surgical technique
On 2 June 2026, the cardiac team performed total arterial, anaortic revascularisation, a technique that restores coronary blood flow using the patient’s own arterial conduits rather than venous grafts harvested from the leg, and without instrumenting the aorta. Three arteries were harvested for the procedure: the left and right internal mammary arteries (LIMA and RIMA) and the left radial artery. Across five new bypass grafts, the surgical team completed 11 precise anastomoses connecting grafts to coronary arteries and to one another, in order to restore perfusion to multiple affected territories of the myocardium.
The operation additionally required coronary endarterectomy to clear hardened plaque from arterial segments with extensive, long-standing blockage, followed by arterial patch reconstruction to repair and widen the affected vessels. Because the procedure was performed off-pump, on the beating heart, the surgical team avoided aortic manipulation altogether – an approach intended to lower the risk of stroke associated with cross-clamping and cannulation of the aorta.
Dr Sandeep Srivastava, consultant cardiothoracic surgeon at Aster Hospital, Al Qusais, said: “This was one of the most technically demanding bypass surgeries we have performed due to the patient’s extensive coronary artery disease. We completed a five-vessel bypass on a beating heart with 11 different forms of arterial connections using the patient’s own arteries, while also removing plaque and reconstructing severely diseased vessels.”
Dr Shipra Srivastava, also a consultant cardiothoracic surgeon at the hospital, added: “By performing the surgery on a beating heart and avoiding manipulation of the aorta, we minimised potential complications of stroke while achieving complete restoration of blood flow.”
The patient remained haemodynamically stable following surgery and had an uneventful recovery. He said: “The doctors explained every step of the treatment, which gave me confidence and reassurance.”
Aster Hospital cardiac surgery programme
Aster Hospital, Al Qusais launched its cardiac surgery programme in November 2024 and has since carried out more than 500 cardiac procedures. Aster DM Healthcare, founded in 1987 by Dr Azad Moopen, operates 16 hospitals, 128 clinics and 360 pharmacies across five GCC countries and Jordan.
