Revolution in surgery

A pioneering procedure offers the hope of a less painful technique than traditional heart bypasses. Doctors in Germany succeeded in turning a vein into an artery to bypass a blockage in the heart of a 53-year-old patient. The operation works a little like redirecting traffic. The blood is sent to the heart muscle instead of going to the heart's pumping chambers.

Dr Stephen Oesterle, the author of a report into the procedure in Circulation: Journal of the American Heart Association, said: "One of the most invasive things you can do in medicine is a coronary artery bypass surgery. "Our ultimate goal is to replace traditional coronary artery bypass with a procedure that does not require surgery."

In traditional bypass operations, the chest is opened and a blood vessel from the calf or the chest is used to bypass the clogged artery. But this is an extremely invasive procedure, which requires lengthy recovery time, and which can be very painful. About 100,000 patients a year might not be eligible for bypass surgery or balloon angioplasty, because their arteries are too badly clogged, says the report.

The German operation was carried out in November 1999 at the Krankenhaus der Barmherzigen Brüder in Trier, Germany.The patient had a heart artery blocked by a build-up of fatty deposits in the vessel walls. Only the top of the artery was working and receiving blood. Dr Oesterle said veins could be used because even when arteries were badly affected, veins were seldom affected.

In this procedure, a catheter system, guided by ultrasound was inserted into an artery in the leg then threaded up through the aorta and into the coronary arteries. A needle was guided through the artery wall into the adjacent vein. Then a thin, flexible wire was threaded through the needle, and the needle and catheter were removed. The wire was attached to a small angioplasty balloon which was used to widen the channel and a tube-like device was inserted to keep it open for blood to pass through. The vein was then blocked above the new channel which had been created.

Blood now flowed in the opposite direction, towards the heart muscle, which had previously been starved of oxygen.Dr Timothy Gardner, spokesman for the American Heart Association said: "The technique described in this report is ingenious."But he said it could only be used for a specific type of bypass, where an artery is open in the first portion, closed in the middle and still supplying good heart muscle.Further trials are to be carried out, with 20 patients set to receive the operation in Germany, and clinical trials due to begin in the US later this year.