The Aortic Program at MHVI combines the expertise of a cardiac surgeon and a vascular surgeon to thoroughly evaluate patients with complex aortic disease. During one visit, both specialists evaluate patients together to determine the least invasive, most effective surgical solution. The surgeons review images and use three-dimensional reconstruction to obtain the high level of detail needed for precise evaluation. “We see each patient together, we operate together, and we take care of patients afterwards together,” says Edward Woo, MD, director, MedStar Vascular Program and co-director of the Aortic Program.
Patients with aortic pathology—dissections, thoracic aneurysms, penetrating ulcers and connective tissue disorders, among other conditions—benefit from this interdisciplinary approach. “Each patient is unique,” says Christian Shults, MD, a cardiac surgeon and co-director of the Aortic Program. “Aortic pathology can be very tricky.” The results are durable and effective surgical solutions, using an endovascular approach whenever possible—about 70 percent of the time. Surgery is performed in a hybrid operating room, with sophisticated imaging and perfusionists employed as needed, so surgeons can perform both open and endovascular procedures.
“Only high-volume centers like ours can have excellent outcomes,” Dr. Shults notes, “especially when it comes to acute emergencies. We have a very sophisticated treatment algorithm that includes
lumbar drains and neuromonitoring.” In addition to interdisciplinary surgical expertise, the Aortic
Program offers the full resources of MHVI. Services also can include genetic screening of selected patients to identify genetically based connective tissue disorders. “This changes the treatment paradigm,” Dr. Shults notes.
The team sees three or four patients each week. “For example, we just saw several patients with type B (descending aortic) dissections,” Dr. Shults notes. “These patients traditionally have been treated medically, but we have found that early intervention with stent-grafts improves long-term survival.” In another example, Dr. Woo recalls a recent patient with an infected aortic arch aneurysm. “These are complex cases that we see on a routine basis.”
In addition to placing conventional stent-grafts, the team is participating in the GORE® TAG® Thoracic Branch Endoprosthesis trial [see related article]. Plans are also in place to participate in more clinical trials of devices with multiple grafts into other branches off the aorta. “Care of these patients is not straightforward or easy,” Dr. Woo says. “But we offer superior outcomes because we treat more patients with complex aortic pathology than any other hospital in the region.”