Health and Medicine
PUBLISHED
A patient who needed lifesaving heart surgery has become the first person ever to receive a coronary artery bypass without being cut open. Such a procedure would usually require open heart surgery, yet doctors successfully performed the operation using minimally invasive techniques that removed the need for a scalpel.
The rest of this article is behind a paywall. Please sign in or subscribe to access the full content.The groundbreaking surgery was conducted on a 67-year-old man whose aortic valve had previously been replaced by a prosthetic. However, a buildup of calcium within this implanted valve now threatened to cause a potentially fatal blockage of the patient’s coronary artery.
Yet doctors were unable to simply replace the implant as it was too close to the opening – or ostium – of the man’s left coronary artery. To complicate matters, the patient also had a history of heart failure, kidney failure, and stroke, making him an unsuitable candidate for open heart surgery.
“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,” explained Emory School of Medicine physician Dr Adam Greenbaum in a statement. Fortunately, he and a group of colleagues were able to come up with a workaround.
“We thought, ‘why don’t we just move the ostium of the coronary artery out of the danger zone?’,” said Greenbaum. “Having a minimally invasive alternative in a case like this is paramount.”
To achieve this, the surgeons used a technique called ventriculo-coronary transcatheter outward navigation and re-entry (VECTOR), which has previously been performed on animals but had never been attempted in a human patient until now. Rather than making an incision in the chest, the procedure involves passing catheters through the blood vessels in the leg in order to reach the heart.
“With no other feasible options, the patient was counseled extensively on, and consented to, VECTOR coronary artery bypass of the left main stem, despite explicitly high risk,” write the team of surgeons in a new study. Using a series of wires, the doctors created small openings in the aorta and the coronary artery, which they then linked using a coronary bypass graft.
This effectively created a new path for the flow of blood, bypassing the potential blockage. Six months on, and the patient continues to show no signs of a coronary artery obstruction, indicating that the procedure was a success.
“Achieving this required some out-of-the-box thinking but I believe we developed a highly practical solution,” said study author Dr Christopher Bruce. However, the team write that further procedures of this kind “in highly selected patients” are now necessary in order to determine whether VECTOR can be considered a reliable alternative to open heart surgery.
The study is published in the journal Circulation: Cardiovascular Interventions.
