Doctors at Henry Ford Health in Detroit have performed a new coronary bypass procedure that was replicated from one not used in decades to treat a patient with crippling angina, a severe symptom of coronary artery disease. The new transcatheter procedure was re-engineered from an operation first developed in the 1950s and opens the door for non-surgical treatment options for thousands of patients who cannot have stents or open-heart revascularization procedures. 60-year-old retired painting contractor, Fred Casciano, became the first person in the world to receive the procedure on April 12th at Henry Ford Hospital in Detroit.
Despite there being many available procedures, many patients are not able to receive the treatments because their coronary arteries are too small or too diseased to achieve effective bypass or stent procedures, according to William O’Neill, Director of the Henry Ford Center for Structural Heart Disease. This medical challenge has led Henry Ford Health investigators to look back at an original operation developed decades ago that required two operations and involved placing a bypass into the main vein in the heart known as the coronary sinus.
The advantage of the original operation was that the bypass was directed to the large disease-free vein. However, it also required two operations about a month apart, and this risky method was later replaced by a safer coronary artery bypass procedure, also known as coronary artery bypass graft (CABG), that became more common in the 1970s. With this new procedure, Henry Ford Health cardiologists are optimistic about the possibility of positively impacting even more patients.
In Casciano’s case, doctors attempted to re-create the original operation without using the open-heart method. A channel between Casciano’s circumflex artery and his coronary sinus was successfully created during the cath lab procedure, and the channel is functioning well. Doctors added that more testing will be done to assess how well the bypass is working.
Before the Henry Ford cardiologists presented this as an option, Casciano had been told he was out of traditional medical solutions and had just one working coronary artery left. Following the successful bypass procedure and a one-day inpatient stay, Casciano returned home with his wife Annette to Northern Michigan, where he has been recovering and getting back to his busy daily routine.
This wasn’t the first time Casciano had received revolutionary treatment. In 2019, Casciano was one of only two patients in the U.S. to receive a coronary sinus reducer implant as part of an FDA approved clinical trial led by Dr. O’Neill. A reduced blood flow in his heart had created the angina condition. About two months after receiving the coronary sinus reducer, which restricts the flow of blood through the veins, Casciano felt well enough to try a new bike trail.
However, when his condition worsened last year, he reached out to Dr. O’Neill for answers. Casciano’s coronary arteries, previously treated with angioplasty and a stent, had narrowed again. In the re-engineered procedure, doctors created a channel from the coronary artery to a vein to bypass the recurring and almost complete blockage that has continued to plague Casciano for much of his adult life.
“It’s an exciting breakthrough that we hope will allow us to treat many more patients with this condition in the future,” said Dr. Khaldoon Alaswad, medical director of the Cardiac Catheterization Laboratory at Henry Ford Hospital in Detroit. The team hopes that, moving forward, this new procedure can provide a much-needed solution for patients who have previously been told that they have run out of treatment options.
