On January 6, 2026, researchers from the National Institutes of Health (NIH) and Emory School of Medicine in Atlanta announced the completion of a coronary artery bypass in a human patient without the need for an open-chest incision. This procedure, named ventriculo-coronary transcatheter outward navigation and re-entry, or VECTOR, addresses the risk of coronary artery obstruction, a rare but serious complication that can follow heart-valve replacement surgery. The intervention was performed on a 67-year-old male patient who was deemed unsuitable for traditional open-heart surgery or existing minimally invasive techniques.
Background and Patient Profile
The procedure was developed to address specific anatomical challenges that can arise during aortic valve replacement. In the patient's case, a 67-year-old male with a history of vascular disease and prior medical interventions, his bioprosthetic aortic valve required replacement due to calcium buildup. The opening (ostium) of his left coronary artery was positioned in close proximity to the valve, indicating a risk of blood flow obstruction during a standard valve replacement. Due to his medical history, traditional open-heart surgery was not considered a viable option, and existing minimally invasive techniques were also deemed unsuitable.
The VECTOR Procedure
The VECTOR procedure aims to create a new blood flow pathway for the coronary artery, circumventing the area of potential obstruction near the aortic valve. This is achieved transcatheterially, using vessels in the patient's legs to access the heart, thereby avoiding an open-chest incision.
The key steps of the VECTOR procedure include:
- Guidewire Placement: A guidewire is advanced through the aorta and into the at-risk coronary artery. From there, it is steered through the artery's wall into the right ventricle of the heart. A separate catheter then ensnares the guidewire within the right ventricle, and its end is pulled out through the femoral vein, establishing a continuous pathway from the aorta to the femoral vein.
- New Ostium Creation: Utilizing this established pathway, a new opening is created in the aorta downstream from the aortic valve, positioned outside the potential zone of blockage. A second opening is made by piercing the coronary artery wall using a specialized catheter, and this opening is then reinforced by an expandable mesh stent.
- Bypass Graft Implantation: Two guidewires are passed through these newly created openings and connected to form a bridge. A coronary bypass graft is subsequently delivered over this guidewire pathway, establishing a new, unobstructed route for blood flow to the coronary artery.
Outcomes and Future Outlook
The VECTOR procedure was performed by Drs. Greenbaum, Babaliaros, and Bruce. Six months following the intervention, the patient exhibited no signs of coronary artery obstruction, indicating the successful initial application of the VECTOR technique in a human.
While this initial human application was successful, researchers state that broader implementation of VECTOR will necessitate further trials involving additional patients. Researchers suggest that the VECTOR technique may also have potential applications in treating other coronary diseases, particularly in instances where conventional approaches, such as stents, have been ineffective in maintaining arterial patency.
Collaborating Institutions and Key Researchers
The research was a collaboration between the National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI) and Emory School of Medicine. Development of the solution involved physicians Adam Greenbaum, M.D., and Vasilis Babaliaros, M.D., both from Emory School of Medicine. Christopher Bruce, MBChB, an interventional cardiologist at WellSpan York Hospital and NIH's NHLBI, and an adjunct assistant professor of cardiology at Emory School of Medicine, served as the study's first author. Bruce and Robert Lederman, M.D., who leads the Laboratory of Cardiovascular Intervention at NHLBI, collaborated on developing the concept into a medical procedure, following successful trials in animal models.