First coronary bypass without opening the chest

Overview

For nearly six decades, coronary artery bypass surgery has required cracking open the chest—a procedure performed more than 300,000 times annually in the United States alone. In May 2025, a team at Emory University and the National Institutes of Health performed the first human coronary bypass through blood vessels in the leg, leaving the chest intact. The 67-year-old patient, who had no other surgical options, showed no complications at six-month follow-up.

The procedure, called VECTOR (Ventriculo-Coronary Transcatheter Outward Navigation and Re-entry), uses catheters to create a new blood vessel pathway around blocked coronary arteries. It mirrors valve replacement surgery's transformation over the past two decades: from open-heart surgery to catheter-based interventions that send patients home the next day. If VECTOR proves durable in further testing, it could eventually spare hundreds of thousands of patients the trauma, infection risk, and months-long recovery of traditional bypass surgery.

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Key Indicators

300,000+

Annual US Bypass Surgeries

Coronary artery bypass grafting remains the most common major cardiac operation performed in the United States.

6 months

Follow-up Without Obstruction

The first VECTOR patient showed no coronary artery obstruction at six-month assessment.

1-5%

Sternal Infection Rate

Deep sternal wound infections occur in 1-3% of open-heart surgeries, with mortality rates of 10-47%.

8h 40m

Procedure Duration

The first human VECTOR procedure took over eight hours—reflecting its technical complexity and early-stage development.

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People Involved

Adam B. Greenbaum

Senior author on VECTOR study; has performed procedure on two patients

Robert J. Lederman

Co-developed VECTOR procedure and contributed to animal model testing

Christopher G. Bruce

Lead author on VECTOR publication

Vasilis C. Babaliaros

Senior author; performed first human VECTOR alongside Greenbaum

Organizations Involved

Emory Structural Heart and Valve Center

Academic Medical Center

Site of first two human VECTOR procedures

Emory's Structural Heart and Valve Center performs high-volume valve replacement procedures and develops novel catheter-based interventions in partnership with NIH.

Laboratory of Cardiovascular Intervention, NHLBI

Federal Research Laboratory

Developed VECTOR technique and tested in animal models

The NHLBI Laboratory of Cardiovascular Intervention develops catheter-based treatments and devices for structural heart disease under real-time MRI and X-ray guidance.

Timeline

May 1967 January 2026

9 events Latest: January 14th, 2026 · 4 months ago

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January 2026
VECTOR Case Published
Latest Publication

The first human VECTOR case is published in <em>Circulation: Cardiovascular Interventions</em>, documenting the technique for the medical community.
January 14th, 2026
November 2025
Six-Month Follow-up Confirms Success
Outcome

First VECTOR patient shows no coronary artery obstruction at six-month assessment; a second patient has also been successfully treated with two conduits.
November 2025
May 2025
First Human VECTOR Bypass Performed
Breakthrough

Emory and NIH physicians perform the first coronary artery bypass through leg vessels on a 67-year-old patient ineligible for open-heart surgery. The 8-hour procedure uses covered stents to create a new blood pathway around blocked arteries.
May 1st, 2025
February 2024
Emory Completes 5,000th TAVR
Milestone

Emory Structural Heart and Valve Center reaches 5,000 transcatheter aortic valve replacements, demonstrating maturation of catheter-based cardiac intervention.
February 2024
January 2019
Emory Structural Heart Center Launches
Development

Emory establishes its Structural Heart and Valve Center with Adam Greenbaum as co-director, beginning a partnership with NIH to develop novel catheter techniques.
January 2019
April 2002
First Human TAVR Procedure
Milestone

The first transcatheter aortic valve replacement is performed, demonstrating that heart valves could be replaced through catheters rather than open surgery.
April 16th, 2002
March 1986
First Coronary Stent Implanted
Milestone

Jacques Puel implants the first coronary stent in Toulouse, France, to treat restenosis after balloon angioplasty.
March 1986
September 1977
First Coronary Balloon Angioplasty
Milestone

Andreas Gruentzig performs the first coronary balloon angioplasty in Zurich, Switzerland, demonstrating that blocked arteries could be opened without surgery.
September 16th, 1977
May 1967
First Modern Coronary Bypass Surgery
Milestone

René Favaloro at Cleveland Clinic performs the first saphenous vein coronary artery bypass graft on a 51-year-old woman, launching the modern era of cardiac surgery.
May 9th, 1967

Historical Context

3 moments from history that rhyme with this story — and how they unfolded.

April 2002 - January 2020

Transcatheter Aortic Valve Replacement (TAVR) Adoption (2002-2020)

French cardiologist Alain Cribier performed the first transcatheter aortic valve replacement in 2002 on a patient too sick for open-heart surgery. Initially restricted to patients at prohibitive surgical risk, the procedure gradually expanded as trials demonstrated safety and efficacy. By 2020, TAVR was approved for patients at all risk levels.

Then

High-risk patients who would have died received a treatment option. Early TAVR required large catheters causing vascular complications.

Now

TAVR now accounts for a majority of aortic valve replacements in the US. Catheter sizes have shrunk from 24-25 French to 14-16 French. Patients typically go home the next day.

Why this matters now

VECTOR follows the same trajectory TAVR established: starting with patients who have no other options, then potentially expanding to broader populations as the technique matures and long-term data accumulates.

September 1977 - August 1994

From Balloon Angioplasty to Coronary Stents (1977-1994)

Andreas Gruentzig performed the first coronary balloon angioplasty in Zurich in 1977, showing blocked arteries could be opened without surgery. But vessels often reclosed. In 1986, Jacques Puel implanted the first coronary stent in France. The Palmaz-Schatz stent received FDA approval in 1994 after trials showed superior results to balloon-only treatment.

Then

Angioplasty offered an alternative to bypass surgery for some patients. Early stents required aggressive blood thinners.

Now

By 1990, angioplasty treated coronary blockages more commonly than bypass surgery. Stents are now used in nearly all angioplasty procedures. Over 1 million percutaneous coronary interventions are performed annually worldwide.

Why this matters now

The progression from primitive balloon angioplasty to sophisticated stent systems took nearly two decades. VECTOR's covered stent grafts may follow a similar refinement path, with next-generation devices improving durability and ease of implantation.

May 1967

Favaloro and the Birth of Coronary Bypass Surgery (1967)

René Favaloro, an Argentine surgeon at Cleveland Clinic, performed the first saphenous vein coronary bypass on May 9, 1967. The patient was a 51-year-old woman with a completely blocked right coronary artery. Within a year, Favaloro had performed 150 procedures with generally excellent results. By 1970, he had completed over 1,000 cases.

Then

Patients with severe coronary disease who would have died had a surgical option. The technique spread rapidly to hospitals worldwide.

Now

Coronary bypass became the most common cardiac operation, with over 300,000 performed annually in the US. Despite advances in stenting, bypass remains the standard for complex multi-vessel disease.

Why this matters now

Favaloro's innovation saved millions of lives but required opening the chest—a limitation that has persisted for 58 years. VECTOR represents the first technique to perform bypass grafting without sternotomy, potentially the biggest change to the procedure since Favaloro's original breakthrough.