Percutaneous Aorto-Coronary Bypass Graft to Prevent Coronary Obstruction Following TAVR: First Human VECTOR Procedure

This first-in-human case report describes ventriculo-coronary transcatheter outward navigation and reentry (VECTOR), a novel percutaneous aorto-coronary bypass technique to prevent coronary obstruction during transcatheter aortic valve replacement. A 67-year-old man with severe bioprosthetic aortic valve stenosis, left ventricular ejection fraction of 20 percent, and prohibitive surgical risk (Society of Thoracic Surgeons mortality 13 percent) had anatomic risk for left main obstruction, with a valve-to-coronary distance of 1.7 mm. Leaflet modification and snorkel stenting were not feasible. VECTOR created an extra-anatomic left main bypass using covered stents before valve implantation. Postprocedural imaging confirmed graft patency and intentional native left main occlusion, with the patient clinically stable at six-month follow-up.