Non-Surgical Bypass Without Anesthesia

In a new procedure that could radically change the way coronary artery bypass procedures are performed, doctors used an ultrasound-guided catheter to redirect blood flow from a diseased coronary artery into a coronary vein that over time widened and transformed itself into an artery. The procedure requires no anesthesia and takes only several hours.

Following catheter insertion, doctors advanced a needle from inside the catheter through the wall of the artery and into the adjacent vein. They then threaded a thin guidewire through the needle, withdrew the catheter and needle, and inserted a small balloon to follow the guidewire and widen the channel. A stent-like device was inserted to keep the channel open for blood flow. Directly above the new channel, the vein was blocked so that blood from the artery would be redirected through the vein toward the heart.

The surgery was performed by Dr. Stephen Oesterle, a cardiologist at Massachusetts General Hospital (Boston, USA), and colleagues on a patient in Germany. More than a year has passed since the surgery, and the patient, who had severe angina before the procedure, to date remains pain free. The new treatment, called percutaneous in-situ coronary venous arterialization (PICVA), is intended for patients who cannot have traditional angioplasty or bypass surgery because of diffuse coronary artery disease. Doctors caution that while the results were encouraging, they are based on a single case and the long-term outcome is unknown.