Heart Surgery at 80: Mr Chua's Keyhole Bypass Story

He felt fine. A routine screening said otherwise.

At 77, Mr Chua Wan Chuan looked the picture of health. He walked daily, felt good, and had no symptoms to speak of. So, when a routine health screening picked up severe blockages in his main arteries, it came as a genuine shock.

“When I first got the news, I was really worried,” Mr Chua recalls. “I didn’t know what to do or what choices I had.”

His daughter, Michelle, remembers it just as vividly: it was a frightening moment for the family – the kind where a seemingly healthy parent is suddenly facing major surgery, with all the uncertainty that comes with it.

The warning signs had shown up quietly. During a treadmill stress test, cardiologist Dr Lim Tai Tian picked up abnormal heart readings – enough to order further tests. A CT scan checked for calcium build-up in Mr Chua's arteries; an angiogram then confirmed how badly all three of his main arteries were blocked.

Why bypass, not stenting, was the answer

Angioplasty with stenting was considered as a less invasive option. But as Mr Chua's blockages were heavily calcified across all three major arteries, Dr Lim advised against it –the long-term risks of repeat procedures, and higher mortality risk, made bypass surgery the safer path forward.

For Mr Chua, “bypass” meant one thing: a large incision across the chest, and a recovery that felt daunting at his age. He wasn't comfortable with it.

That's when the team introduced an alternative: minimally invasive cardiac surgery (MICS), also known as keyhole cardiac surgery, performed through small incisions and endoscopic instruments rather than opening the chest.

According to (Adj) Prof Theodoros Kofidis, the cardiothoracic surgeon who would go on to perform Mr Chua's surgery, suitable candidates generally need a reasonably healthy chest size relative to their heart, no major calcium build-up in the aorta, and heart function within a good range – factors that ruled Mr Chua in.

Prof Kofidis, who has practised minimally invasive techniques for over two decades, estimates that around 50 to 60% of patients qualify overall, with anatomy – smaller, flatter chest structures common in Asia – sometimes a limiting factor.

Mr Chua was cleared for it.

“When we got the green light, my dad was relieved,” Michelle says. “He was thrilled he could have the bypass without the trauma of a major chest operation.”

Surgery, and a recovery that surprised the whole family

“On the second day, I was able to walk; then on the fifth day, I climbed the stairs,” Mr Chua recalls. “I was discharged within a week.”

Michelle remembers her father walking more slowly at first, and worrying whether he'd get his old pace back. But he kept at it, a little further each day, until weeks later he was walking exactly as he had before.

It's a pattern MICS patients tend to share: because the chest cavity stays intact, there's less trauma, less blood loss, lower infection risk, and evidence that lung function recovers better too. Where a conventional open bypass can mean over three months before a full return to daily activities, MICS patients are often back to normal within about three weeks.

The bigger lesson: symptoms aren't the whole story

For Dr Lim, Mr Chua's case is a reminder of something he sees often: the absence of symptoms doesn't mean the absence of heart disease.

Women in particular, he notes, often present without the classic chest pain or breathlessness, sometimes just unexplained tiredness, or nothing at all. Men more typically report chest pain or shortness of breath, but not always.

That's part of why he encourages patients to look at risk factors, not just symptoms – age, smoking history, diabetes, blood pressure, cholesterol, exercise habits, and family history all matter.

Routine heart health screening is generally recommended starting at age 40 for healthy adults, though basic cardiovascular risk assessments should begin as early as age 18.

A family member diagnosed young, he notes, can put even a decade-younger relative at elevated risk; diabetes alone can raise heart disease risk by four to eight times. “If you wait for the symptoms,” he says, “it might be too late.”

Routine heart health screening is generally recommended starting at age 40 for healthy adults, though basic cardiovascular risk assessments should begin as early as age 18.

Mr Chua and Dr Lim's collaboration with Prof Kofidis, cardiologist and cardiothoracic surgeon working as one heart team – reflects how Mount Elizabeth Hospitals typically approaches heart care, from straightforward cases to more complex ones.