First Nonsurgical Coronary Artery Bypass Performed
A 53-year-old man from Germany has become the first person to successfully undergo a new nonsurgical coronary artery bypass procedure: percutaneous in situ coronary venous arterialization (PICVA).
“This milestone marks the first coronary artery bypass performed with a catheter,” Dr. Stephen N. Oesterle, of Massachusetts General Hospital in Boston, said in a statement released by the American Heart Association (AHA).
The patient had severe angina due to total occlusion of the mid-left anterior descending coronary artery and was not a candidate for traditional bypass surgery or balloon angioplasty. The PICVA procedure allowed cardiologists to arterialize the anterior interventricular vein adjacent to the occluded artery.
Dr. Oesterle, with other cardiologists from the US, Japan and Germany, describes the technique in the May 29th issue of Circulation: Journal of the American Heart Association.
The procedure, performed in the cardiac catheterization lab, involves using an ultrasound-guided catheter system to advance a needle through the arterial wall into the adjacent interventricular vein. “Using standard angioplasty techniques, a fistula [is] then constructed from the proximal artery to the coronary vein using a self-expanding connector,” the authors explain.
The procedure was performed in November 1999 without complication, and an angiogram taken 3 months later “confirmed continued patency of the arteriovenous connection,” the investigators report. The patient has been free of angina for 12 months.
In the AHA release, Dr. Timothy Gardner, from the Hospital of the University of Pennsylvania, in Philadelphia, called the technique “ingenious.”
But he did caution, in a telephone interview with Reuters Health on Friday, that the report describes short-term success in only one patient whose PICVA treatment was used in only one blocked artery. “The vast majority of coronary artery patients who require angioplasty or bypass surgery need to have multiple blockages opened or bypassed,” he pointed out.
“This new and very innovative technique must be proven safe and effective in many patients, especially those with more common patterns of coronary artery obstructions, before it is suggested that it will replace conventional angioplasty or bypass surgery.”
Further studies need to determine the durability of PICVA and the risk of “late heart circulation problems, such as too much blood flow into the coronary veins,” he added.
Dr. David Faxon, president-elect of the AHA, said that the procedure may be particularly useful in the increasingly large group of patients with chronically occluded vessels, “but it won’t be a solution for everyone.”
Circulation 2001;103:2539-2543.
