Researchers Perform First Minimally Invasive Coronary Artery Bypass
By Health Correspondent
In a world first, researchers at the National Institutes of Health (NIH) and Emory School of Medicine in Atlanta have successfully carried out a coronary artery bypass without opening the chest.
Coronary artery bypass surgery is usually a form of open-heart surgery. This new approach avoided cutting through the chest wall.
The team used a new method to prevent blockage of a major coronary artery. This blockage is a rare but often fatal complication that can occur after heart valve replacement.
The results suggest that, in the future, people at high risk could have access to a safer and less invasive alternative to open-heart surgery.
“Achieving this required some out-of-the-box thinking but I believe we developed a highly practical solution,” said Christopher Bruce, MBChB, first author of the study.
He is an interventional cardiologist at WellSpan York Hospital and NIH’s National Heart, Lung, and Blood Institute (NHLBI), and an adjunct assistant professor of cardiology at Emory School of Medicine.
The patient was a 67-year-old man whose aortic valve, which controls blood flow from the heart to the body, had previously been replaced with a bioprosthetic valve. Over time, calcium buildup meant the valve needed to be replaced again.
However, the patient’s anatomy placed the opening of his left coronary artery extremely close to the valve. This meant a standard valve replacement would likely block blood flow to the heart.
“Our patient had an extensive history of prior interventions, vascular disease, and other confounders, which meant that open-heart surgery was completely off the table. Having a minimally invasive alternative in a case like this is paramount,” said Adam Greenbaum, M.D., a senior author of the study and physician at Emory School of Medicine.
Because of several anatomical challenges, the patient was also not suitable for existing minimally invasive options. At the time, Greenbaum and Vasilis Babaliaros, M.D., at Emory were already developing a new approach designed for complex cases like this.
“We thought, ‘why don’t we just move the ostium of the coronary artery out of the danger zone?’,” Greenbaum said.
Bruce and Robert Lederman, M.D., who leads the Laboratory of Cardiovascular Intervention at NHLBI, joined the Emory team to turn this idea into a workable procedure. The method had already been tested successfully in animal models.
The procedure is called ventriculo-coronary transcatheter outward navigation and re-entry, or VECTOR. It creates a new pathway for blood flow that stays safely away from the aortic valve.
Instead of opening the chest, doctors reach the heart by guiding catheters through blood vessels in the legs. While entering the heart this way is not new, what the researchers do once inside is unique.
Using VECTOR, the team guides a wire from the aorta into the at-risk coronary artery. The wire is then directed into a small branch of the artery and carefully passed into the right ventricle, one of the heart’s chambers. A second catheter captures the wire and pulls it out through a vein in the leg. This creates a continuous pathway that allows doctors to insert more advanced tools into the artery.
Next, the team creates a new opening for blood flow. One hole is made in the aorta below the valve, safely away from potential blockage. A second opening is created in the coronary artery using a special catheter supported by a stent. The two openings are connected with a wire to form a new, safe route for blood flow.
A coronary bypass graft is then placed through these new openings. Once in position, the graft allows blood to flow freely, avoiding the blocked area.
Greenbaum and Babaliaros, along with Bruce, carried out the procedure on the patient.
Six months later, the patient showed no signs of coronary artery blockage.
This confirmed that the first use of VECTOR in a human was successful. While more patients will need to be treated before the technique is widely used, the researchers are encouraged by these results.
The team also believes the method could help treat other coronary artery diseases, especially in cases where treatments such as stents are not effective.
“It was incredibly gratifying to see this project worked through, from concept to animal work to clinical translation, and rather quickly too. There aren’t many other places in the world that can move as quickly and successfully as we can at NIH in collaboration with our partners at Emory,” Bruce said.
REFERENCE: C Bruce, et al. Percutaneous aorto-coronary bypass graft to prevent coronary obstruction following TAVR: First human VECTOR procedure. Circulation: Cardiovascular Interventions. 2026. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.125.016130
