Beyond Bypass: Next Generation Coronary Revascularization

Traditional coronary artery bypass graft (CABG) surgery has been refined to be the most effective long-term treatment for occluded coronary arteries. Yet it remains a major surgical procedure that is traumatic for patients. Various minimally-invasive approaches to cardiac surgery have been developed but adoption rates are slow because these new procedures don't yet measure up to traditional CABG and because heart surgeons are slow adopters of new technology. Recent discoveries in coronary physiology have opened the door for new approaches to creating cardiac perfusion in a patient with occluded vessels. But this requires physicians to re-think what they were taught in medical school. One such approach, which involves direct vascularization from the ventricle, is being pursued by three companies: Percardia, HeartStent and Ventrica. Another company, TransVascular, is taking a broader approach by using the venous system to bypass arterial blockages. Approaches that require physicians to think differently about basic science, along with the tortuous clinical and regulatory path for new cardiac surgery devices and the cautious nature of cardiothoracic surgeons, present significant challenges to these start-up companies.