Surgeons Just Performed the First Open Heart Surgery Without Ever Opening the Chest. Here’s How.

3 min read

FOR THE FIRST time, doctors have successfully completed a coronary artery bypass without cutting the patient open. They recently documented the results of the landmark surgery in Circulation: Cardiovascular Interventions.

The surgery was done on a 67-year-old man whose aortic valve was already replaced with a prosthetic. However, he developed a buildup of calcium and the prosthetic needed replacing. But there were several reasons he couldn’t get a valve replacement.

He had a history of kidney failure, stroke, and heart failure, making him too high risk for open heart surgery. In addition, the patient’s implant was in a place (super close to the opening of his left coronary artery) where undergoing a standard valve replacement would risk blocking blood flow. He also was an unsuitable candidate for other minimally invasive heart procedures.

To work around these issues, doctors had a creative solution: Instead of cracking open the man’s chest, they would go an artery in his leg.

“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,” says Adam Greenbaum, MD, senior author of the study and a physician at Emory School of Medicine. “We thought, ‘why don’t we just move the ostium of the coronary artery out of the danger zone’.”

The unconventional technique is known as VECTOR (ventriculo-coronary transcatheter outward navigation and re-entry). It involves creating a new route for blood flow by slipping catheters through blood vessels in the leg to reach the heart. Passing a wire from the the aorta and into the at-risk coronary artery allows for doctors to load more sophisticated tools to the target area. VECTOR has been tested in animals, but never in humans.

“Achieving this required some out-of-the-box thinking but I believe we developed a highly practical solution,” says Christopher Bruce, MBChB, an interventional cardiologist at WellSpan York Hospital and NIH’s National Heart, Lung, and Blood.

After 6 months, the man shows no signs of coronary artery obstruction. In other words, the experimental surgery was a success. Cheng-Han Chen, MD, interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center who was not involved in the surgery, had a positive reaction to the news.

“This was a case of an extremely creative and novel method for forming a new artificial bypass for blood to the coronary arteries,” he explains. “Whereas a heart surgeon would traditionally need to cut open the chest to create a bypass, this procedure utilized minimally invasive techniques and equipment to accomplish the same result.”

The study authors caution that more tests need to be made before VECTOR is used widely. If it continues to prove successful, they say VECTOR could provide a minimally invasive option to open heart surgery. It could also treat coronary diseases more broadly. For example, VECTOR may potentially be used in situations where stents fail to keep arteries open.

“New innovations such as these continue to push the field forward, and offer hope to many of our patients with unmet medical needs unable to benefit from current treatments,” adds Chen. “While this particular case required very specialized experience and equipment to perform, advancements in technique may potentially allow us to perform coronary artery bypass through minimally invasive approaches in the future.”