Researchers perform first minimally invasive coronary artery bypass graft

Tuesday January 6, 2026

For high-risk patients, this method could offer a safer alternative to open-heart surgery.

In a world first, a team of researchers from the National Institutes of Health (NIH) and Emory School of Medicine in Atlanta has successfully performed coronary artery bypass grafting – a normally open-heart operation – without cutting the chest wall. The team used a new procedure to prevent blockage of a vital coronary artery, a very rare but often fatal complication after heart valve replacement. The findings suggest that in the future, a less traumatic alternative to open heart surgery may become widely available for people at risk of coronary artery blockage.

“Achieving this required some out-of-the-box thinking, but I believe we have developed a very practical solution,” said study first author Christopher Bruce, MBChB, an interventional cardiologist at WellSpan York Hospital and the NIH’s National Heart, Lung, and Blood Institute (NHLBI), as well as an adjunct assistant professor of cardiology at Emory School of Medicine.

The patient was a 67-year-old man whose aortic valve – which allows blood to flow from the heart to the aorta, the body’s largest artery – had previously been replaced with a bioprosthesis, but, due to calcium buildup, the replacement now needed to be replaced. However, this patient’s unique anatomy placed the opening, or ostium, of his left coronary artery so close to the valve that his vital blood flow would likely be blocked during the standard valve replacement procedure.

“Our patient had an extensive history of prior procedures, vascular disease, and other confounding factors, which meant open-heart surgery was completely off the table. Having a minimally invasive alternative in a case like this is paramount,” said Adam Greenbaum, MD, lead author of the study and a physician at Emory School of Medicine.

Due to several anatomical quirks, the patient was also not a good candidate for existing minimally invasive solutions. Fortunately, Greenbaum and Vasilis Babliaros, MD, at Emory, had recently begun developing a solution specifically for this type of scenario.

“We thought, ‘Why not just move the ostium of the coronary artery out of the danger zone?’ “, Greenbaum said.

Bruce and Robert Lederman, MD, who directs the NHLBI’s Cardiovascular Intervention Laboratory, joined Emory physicians to help turn their concept into a viable medical procedure, after successfully using it in animal models.

The procedure, called ventriculocoronary catheter forward and reentry navigation, or VECTOR, creates a new pathway for blood flow that is a safe distance from the aortic valve. And rather than opening the chest to do this, researchers use the body’s natural vascular circuits to reach the heart, sliding catheters into the vessels in the legs. Although this method of access is not new, what the authors of the study do with their tools once there is.

With VECTOR, researchers pass a wire through the aorta and into the coronary artery at risk. From there, they direct the wire deep into one of the artery’s branches, piercing the vessel to the right ventricle, one of the four chambers of the heart. There, they use a separate catheter to trap this wire, then pull the end of the wire through the femoral vein. Now a continuous line from the aorta to the vein, this wire allows the loading of more sophisticated tools into the target artery.

VECTOR’s next goal is to produce a new ostium for coronary artery bypass grafting. They create a hole in the aorta downstream of the valve, out of reach of a potential blockage. Researchers make a second opening by piercing the wall of the coronary artery using a special catheter, reinforced with an expandable mesh tube, called a stent. They pass two loose ends through each of the holes and then, as in the previous phase, tie them together to create another bridge, this time making a safe path for the bypass.

Using this second wire, the team passes a coronary artery bypass graft through the two new openings. Once deployed, the graft provides a new route of blood circulation out of danger.

Greenbaum and Babaliaros of Emory, joined by Bruce, put these steps into practice in their patient.

Six months after the procedure, the patient showed no signs of coronary artery blockage, meaning that the first use of VECTOR in humans was successful. Further deployments in more patients are still needed before VECTOR is used more widely, but the team hopes for continued success after this major breakthrough.

The authors suggest that the new technique could also find a place in treating coronary heart disease more broadly, in cases where other approaches, such as stents, fail to keep the arteries open.

“It’s been incredibly rewarding to see this project come to fruition, from concept to animal work to clinical translation, and quite quickly too. There aren’t many other places in the world that can scale as quickly and successfully as we can at NIH in collaboration with our partners at Emory,” Bruce said.

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research into heart, lung and blood diseases and sleep disorders that advances scientific knowledge, improves public health and saves lives. For more information, visit https://www.nhlbi.nih.gov.

About the National Institutes of Health (NIH): The NIH, the nation’s medical research agency, is comprised of 27 institutes and centers and is part of the U.S. Department of Health and Human Services. The NIH is the primary federal agency that conducts and supports basic, clinical, and translational medical research, and studies the causes, treatments, and cures for common and rare diseases. For more information about the NIH and its programs, visit www.nih.gov.

NIH…Transforming discovery into health^®

Reference

C Bruce et al. Percutaneous coronary artery bypass grafting to prevent coronary obstruction following TAVR: first human VECTOR procedure. Circulation: cardiovascular interventions. 2026. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.125.016130