First human coronary bypass surgery performed without chest cracking

For the first time ever in a human, doctors have performed coronary artery bypass grafting without having to cut through the patient’s chest, similar to how many aortic valve replacement procedures are now done.

The CABG procedure re-routes blood around a blockage in an artery carrying blood to the heart. In this case, the surgical tools were inserted and threaded through a blood vessel in the patient’s leg, according to a report published in Circulation Cardiovascular Interventions.

The results suggest that, in the future, a less traumatic alternative to open-heart surgery could become widely available for those at risk of coronary artery obstruction, researchers said.

“Achieving this required some out-of-the-box thinking but I believe we developed a highly practical solution,” said team leader Dr. Christopher Bruce of the U.S. National Heart, Lung, and Blood Institute and Emory School of Medicine.

The procedure is called ventriculo-coronary transcatheter outward navigation and re-entry, or VECTOR.

The patient in this first case was not a candidate for traditional open-chest CABG because of heart failure and old, poorly functioning artificial heart valves.

Six months after the procedure, the patient showed no signs of coronary artery obstruction, meaning the VECTOR approach was a success.

Further testing in more patients is necessary before VECTOR is used more widely, but its successful debut is a major step in that direction.

“It was incredibly gratifying to see this project worked through, from concept to animal work to clinical translation,” Bruce said.

RESEARCHERS TRACK CELLS OF HARD-TO-TREAT CANCER IN BLOOD

Newly identified tumor cell characteristics will improve the ability of doctors to track some of the most aggressive breast cancer cells as they travel through the bloodstream to spread to other organs, researchers say.

Triple-negative breast cancer, among the most aggressive of all cancers, is hard to treat because its cells lack the hormone proteins on their surface that are targeted by standard therapies. Furthermore, triple negative tumors are more likely to metastasize than other forms, but tracking the tumor cells as they move has been challenging.

But researchers have now identified four new cell-surface proteins that significantly improve the identification of triple-negative breast cancer cells as the cells circulate in patients’ blood, they reported in Cancer Research Communications.

They first focused on mouse models of metastatic triple-negative breast cancer and then confirmed their findings in patient samples.

“We were excited with the results with blood from patients with metastatic TNBC,” study leader Dr. Chonghui Cheng of Baylor College of Medicine said in a statement.

“In these patients, tumor cells were frequently undetectable using standard markers but became clearly visible when we applied the new marker combination,” she said.

Being able to reliably detect circulating triple negative breast cancer cells could help doctors monitor disease progression and treatment response more accurately, the researchers said.

“Another exciting finding is that the newly identified markers are also expressed in other cancer types, suggesting that this strategy could improve… detection across multiple cancers,” Cheng said.

SMOKING CESSATION DRUG MAY ALSO HELP CANNABIS USERS CUT BACK

A drug used to help smokers quit showed some promise for treating cannabis use disorder in a small mid-stage trial, researchers said, although the benefit was clear only in men.

Cannabis use disorder is characterized by continued use of cannabis despite ‘clinically significant impairment’ such as ignoring important social, occupational, or recreational activities, and despite physical or psychological problems such as psychosis, sleep disorders, withdrawal, and mood and anxiety disorders.

Researchers tested the smoking cessation drug varenicline, sold by Pfizer PFE.N under the brand name Chantix. The 174 trial participants were randomly assigned to receive varenicline or placebo for 12 weeks, along with a brief weekly medical management session.

Men who received varenicline averaged 7.9 weekly cannabis-use sessions during the study and 5.7 sessions in the week after the study, compared with more than 12 weekly sessions for the placebo group, the researchers reported in Addiction.

Women who received varenicline had higher anxiety with no decrease in cannabis use, compared to women in the placebo group.

“Our next step is to further explore varenicline for cannabis use disorder using a larger sample size of women to better understand this sex difference in the treatment outcome,” study leader Aimee McRae-Clark of the Medical University of South Carolina said in a statement.

“(Earlier) studies have indicated that females are more likely to use cannabis as a coping strategy for tension and stress,” the researchers noted in their report.

Because higher anxiety with varenicline may have contributed to poorer outcomes in women, future trials should include psychosocial support targeting anxiety as a trigger for continued cannabis use, they suggested.