August 16, 2016
Vascular and cardiac surgeons team up in new multidisciplinary Aortic Center
Patients at University Hospitals Harrington Heart & Vascular Institute have access to a new multidisciplinary center that provides coordinated evaluations and treatment options for aortic pathologies. The new Aortic Center, led by UH vascular surgeon Vikram S. Kashyap, MD, Chief, Divsion of Vascular Surgery & Endovascular Therapy, UH Cleveland Medical Center, C-Chair, Clinical Executive Committee, adn Co-Director, Aortic Center, UH Harrington Heart & Vascular Institute; Professor of Surgery, Case Western Reserve University School of Medicine and UH cardiac surgeon Yakov Elgudin, MD, PhD, Co-Director, Aortic Center, and Co-Director, Coronary Clinic, Center, UH Harrington Heart & Vascular Institute; Assistant Professor of Surgery, Case Western Reserve University School of Medicine also draws on the expertise of other experienced vascular and cardiac surgeons, as well as interventional cardiologists and experts in cardiovascular medicine, imaging and genetics.
“Aortic pathologies are very often complex,” says Dr. Kashyap. “They require a multidisciplinary team with highly trained and experienced subspecialists working side by side.”
“Patients with aortic root and ascending aortic and arch aneurysms or dissections require long-term follow-up and frequently complex interventions on descending thoracic and abdominal aorta,” adds Dr. Elgudin. “Cardiac and vascular surgeons at our center work closely together to make sure the follow-up is provided and required interventions are performed in a timely fashion.”
Advanced imaging available at the Aortic Center includes coronary computed tomography angiography (CTA), magnetic resonance angiography (MRA), angiography and intrasvascular ultrasound (IVUS). Therapies include leading-edge surgical techniques, such as complex aortic root reconstructions (including valve-sparing aortic root replacement) and surgical reconstruction of ascending aneurysms, arch pathologies and thoraco-abdominal aneurysms. At the same time, the Aortic Center also offers innovative technologies in endovascular therapy, providing minimally invasive stent therapies for aneurysms, dissections and other aortic pathologies. Complex endovascular therapies include endovascular aortic repair (EVAR), fenestrated endovascular aortic repair (FEVAR) and thoracic endovascular aortic repair (TEVAR). To treat descending aortic aneurysms, the Aortic Center at UH offers the staged and combined surgical-endovascular “elephant trunk” procedure. In addition, the center offers surgical and stent-graft treatment options for type A and type B aortic dissections.
“We have extensive experience in endovascular therapies for abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA) and transcatheter aortic valve replacement (TAVR),” Dr. Kashyap says. “In addition, we have excellent results and large experience in treating acute aortic dissection.”
One hallmark of the new Aortic Center is its participation in clinical research. Appropriate patients treated for AAA or TAA with a Gore endovascular device are enrolled in the Global Registry for Endovascular Aortic Treatment (GREAT) registry, which is collecting 10 years of patient and device performance data. The Aortic Center at UH is also one of just 11 national sites participating in the Rehearsal clinical trial, a multicenter, randomized study to compare the performance of endovascular AAA procedures with and without prior rehearsal using a virtual procedure rehearsal studio. Select AAA patients at UH are also enrolled in the LEOPARD (Looking at EVAR Outcomes by Primary Analysis of Randomized Data) trial. This post-market study aims to test which endovascular device approach is best for AAA patients – one that employs fixation of the endograft on the aortic bifurcation or one that relies on penetrating hooks and barbs for device fixation within the aorta.
Beyond surgical and endovascular approaches, the Aortic Center at UH offers medical therapies for asculitis and nonatherosclerotic occlusive disease of the aorta and branches.
In addition, through the Center for Cardiovascular Genetics within UH Harrington Heart & Vascular Institute, the Aortic Center offers genetic evaluation and counseling for patients and families affected by Marfan’s syndrome and Loeys-Dietz syndrome and other aortopathies.
“This is the beauty of a ‘virtual center’ such as ours,” Dr. Kashyap says. “Each member or component within UH Harrington Heart & Vascular Institute continues to see patients at the usual venue. But then we collaborate across disciplines to review cases and get the best outcomes for our patients.”
AORTIC PATHOLOGIES TREATED AT THE AORTIC CENTER
- Aorto-annular ectasia
- Aortic root aneurysm
- Aneurysms of the ascending aorta, aortic arch, and descending thoracic and abdominal aorta
- Thoraco-abdominal aortic aneurysms
- Aortoiliac occlusive disease
- Acute and chronic aortic dissections
- Penetrating aortic ulceration
- Intramural hematoma
- Aortic atherosclerosis
- Marfan’s syndrome
- Loeys-Dietz syndrome