Almost everyone knows someone in the Zipper Club. That’s the informal name for the millions of people who have survived open-heart surgery and carry the long vertical scar down their sternum as proof. It means a cracked chest, months of painful recovery, and a body that is never quite the same. For decades, if you needed a coronary bypass, that was simply the deal.
But what if it didn’t have to be?
This week on The Heart of Innovation, we featured Dr. Chris Bruce, part of a research collaboration between the NIH and Emory University that just performed something that has never been done in human history:
A fully catheter-based coronary bypass, completed without opening the chest, on a beating heart, through a tiny puncture in the groin.
They are calling it VECTOR.
Joining us as co-host was Dr. James Joye, an interventional cardiologist who invented a minimally invasive catheter-based bypass technique for the leg arteries, now distributed by Endologix, and who has spent decades thinking about how to bring that same philosophy to the heart.
When I asked Dr. Bruce whether VECTOR signals the beginning of the end for the Zipper Club, he didn’t oversell it.
“I would love to think so, but we’re very early on. If you think back to people putting transcatheter heart valves in patients 15 or 20 years ago, people probably thought they were a little bit crazy and on the edge, and now it’s mainstream in most hospitals worldwide. I don’t know where it’s going to go in 15 or 20 years, but it’s nice to think that it might inspire other people to get creative and think about how we can make this a procedure for more than just the very, very sick with no other options.”
That framing matters, because the patient who received the world’s first VECTOR procedure was exactly that: someone with no other options.
A procedure invented for one patient
The NIH and Emory collaboration has a track record of tackling complex medical situations where no good options exist commercially. Dr. Bruce walked us through what made this case so unusual. The patient had a surgically replaced heart valve that had become severely narrowed over time. A second open-heart surgery was the obvious answer, but the patient was too sick to survive it.
“They’ll die on the table, essentially, if we try.”
So the team turned to placing a new valve inside the old one via catheter from the leg, a less invasive approach they use regularly. But in this patient, doing that would cause the old valve’s leaflets to swing open like trapdoors and block the left coronary artery, which supplies blood directly to the heart muscle. Block that, and as Dr. Bruce explained, you get a massive heart attack on the table with essentially 100% mortality without heroic intervention. Techniques exist to cut the leaflet down the midline so it opens like a window rather than a trapdoor, but this patient’s leaflets were so calcified that those weren’t viable either.
That’s when the idea came.
“He really was a patient with no options. So in talking about the patient, the idea came: if we’re going to block the artery, why don’t we just move it out of the way?”
The Saturday morning phone call that started it all
Dr. Bruce described the moment the plan took shape. It was a Saturday morning when Dr. Robert Lederman at the NIH called him.
“He said, I’ve just come off the phone with Vasilis, and we’re going to move the coronary artery. And I was like, okay, sure.”
Dr. Joye, who has been through the process of translating a novel catheter technique into clinical use, laughed at that. Moving a coronary artery through open-heart surgery is something cardiac surgeons do. Moving one through a catheter, without opening the chest, on a beating heart, had never been done.
What followed was a period of iteration in the animal lab at the NIH, working through the technique step by step until it was refined enough to attempt in a human. Dr. Bruce described spending four and five hours at a stretch in those animal sessions, working through failed attempts and learning from each one. Then the team analyzed the patient’s CT scans in detail, mapped out every projection angle and contingency, and went to Emory to attempt it for the first time in a human being.
“We were all pretty relaxed, to be honest, going in by the time we did it.”
What actually happened in that lab
Dr. Joye explained the mechanics for our audience in terms that cut through the clinical language. The coronary arteries originate at the base of the aorta, just above the heart. What the team did was create a new connection point higher up on the aorta, above where the new valve would sit, so blood could still reach the heart after the valve was deployed. They did this entirely through catheters.
One wire was advanced backward through the coronary artery and pushed out through the vessel wall. A second wire was burned through the wall of the aorta using an electrosurgical generator. Both wires then had to meet in the pericardial space, the natural cavity between the lining of the heart and the heart muscle itself, where a snare on one catheter captured the other wire and pulled it through. A covered stent was then deployed to bridge the two exit points, acting as the new conduit for blood.
The procedure itself took about five hours. The patient was in the lab for seven to eight hours in total.
There was one complication: bleeding into the pericardium. Dr. Bruce was matter-of-fact about it.
“That did happen at one point in the procedure, bleeding into the lining of the heart, into the pericardium, and we had to pop a needle in and drain that off. But again, expected. We reacted very quickly to that. There’s always unexpected things. Thankfully, none of those happened.”
He drew a clear distinction between expected complications, the ones you have a contingency for going in, and unexpected ones. The bleeding was the former.
Then came the moment of truth. After everything was in place, the team deployed the new heart valve. The old leaflets swung shut as predicted, blocking the original route to the coronary artery. Everyone waited to see whether blood would flow through the new catheter-built graft instead.
“It was quite reassuring to see good blood flow down into the coronaries through the graft, despite us having blocked it as predicted.”
How the patient did
The procedure was performed about a year before we spoke. Dr. Bruce delivered the update plainly.
“The patient, unfortunately, is no longer with us, but not related to a complication of this. There were a lot of other things going on that were life-limiting in the longer term for him as well. But when he passed away from other issues, there was no sign of any heart attack or ischemia or anything from the things that we did, which was of some reassurance after 9 or 10 months.”
A second patient has since undergone a version of the procedure involving both coronary arteries. The technique is being refined.
Where this could go
Dr. Bruce was thoughtful about the road ahead. He sees potential applications beyond the specific valve scenario that prompted this first case, including calcified lesions where coronary arteries meet the aorta, stents that fracture or fail to expand, and eventually more traditional coronary bypass grafting. He even sketched out a future worth imagining:
“You could imagine a world where you can have a robotic off-pump Lima to LAD, and then vector grafts to the circumflex and right. Those kind of things, we’re thinking.”
Dr. Joye, who knows from experience what it takes to get from a novel idea to something that works reliably in a broad range of hands, named the real challenge ahead.
“Doing it is one thing in a 7- or 8-hour procedure, but breaking it down to something that can be done in 90 minutes in kind of anybody’s hands is really the challenge.”
VECTOR is not the end of open-heart surgery. But it is a documented, peer-reviewed proof that a coronary bypass can be performed through a catheter on a beating heart without cracking a chest. That has never existed before. And if the history of procedures like TAVR tells us anything, the distance between a first-in-human case and a mainstream standard of care can close faster than anyone expects.
Watch the full conversation at the top of this article.
For more information you can also call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS
