New Center for Aortic Care Offers Options for Complex Cardiac Patients

A ruptured aortic aneurysm or dissection is a life-threatening emergency. And patients with aortic disease — including those deemed appropriate for “watchful waiting” — can face a complex healthcare journey that requires sophisticated care. With the launch of the Center for Aortic Care at Baptist Health Miami Cardiac & Vascular Institute, patients now have a multidisciplinary team of experts by their side in South Florida.

The body’s largest blood vessel, the aorta, transports blood from the heart to the rest of the body. A weak spot anywhere in the vessel’s 11 segments can cause it to bulge and eventually rupture. Similarly, a tear or separation in the layers of the aortic wall can lead to death.

“Our new center for aortic care is dedicated to providing patients the highest level of expertise and innovative treatments for aortic conditions,” says says Tom C. Nguyen, M.D., chief medical executive, director of minimally invasive valve surgery, and Barry T. Katzen Medical Director Endowed Chair of Baptist Health Miami Cardiac & Vascular Institute. “With an experienced team at the helm, we’re equipped to address the most complex cases, offering hope and life-saving care to those dealing with aortic disease.”

According to a study published in the Journal of Vascular Surgery, aortic aneurysm-related deaths jumped 81.6 percent between 1990 and 2019. That statistic, along with the evolution in treatment for aortic disease, prompted the American Heart Association and the American College of Cardiology to develop new clinical practice guidelines. 

Followed by Miami Cardiac & Vascular Institute physicians, the evidence-based guidelines call for earlier intervention for some patients. Importantly, it also urges patients to seek care at dedicated, high-volume aortic care centers that use shared decision-making in treatment planning. 

The best outcomes occur in the hands of extremely experienced and specialized physicians, says cardiothoracic surgeon Mehrdad Ghoreishi, M.D., who is also co-director of aortic surgery and medical director of cardiac surgery research at Miami Cardiac & Vascular Institute.

“Aortic disease is a common condition, but it requires a multidisciplinary team that includes cardiac surgeons, vascular surgeons, interventional radiologists, cardiologists, hypertensive cardiologists, cardiac imaging specialists and genetic consultants,” he says. “At the Center for Aortic Care, we can provide treatment for a problem in any segment of the aorta. There aren’t many centers in the country that can provide this level of care for aortic disease.” 

Risk factors

September is Aortic Disease Awareness Month, and the experts at Miami Cardiac & Vascular Institute want to spread the word about the risk factors for aortic disease. They include:

• Increasing age
• Being born male
• Smoking and tobacco use
• Uncontrolled high blood pressure and cholesterol
• A family history
• Certain genetic conditions, such as Marfan syndrome, Vascular Ehlers-Danlos syndrome or Loeys-Dietz syndrome
• Having a bicuspid aortic vale
• Diabetes 

Symptoms

Many times, small aneurysms cause no symptoms. They are often discovered when a patient has an imaging study for another reason. Depending on its location and size, an aneurysm may cause:

• Chest, jaw or upper back pain, a cough or shortness of breath, or trouble swallowing, particularly if located in the thoracic area

• Back or belly pain, particularly if located in the abdomen

A rupture or tear usually causes sudden, severe pain and may also result in low blood pressure, a rapid heartbeat, dizziness or fainting, and nausea or vomiting. It requires emergency care.

New guidelines

In the past, surgeons usually recommended careful monitoring of aneurysms less than 5.5 cm in size. Now, however, they agree that some patients may benefit from intervention even if their aneurysm is 5 cm or smaller.

“The key here is to avoid a catastrophic emergency,” Dr. Ghoreishi says. “For appropriate patients with smaller aneurysms and a low risk of complication, surgery may be beneficial. But the new guidelines are clear that aneurysms of 5 cm and smaller should only be operated on at high-volume aortic centers like ours.”

Additionally, the growth of an aneurysm also helps determine if intervention is necessary. If aortic root growth or ascending aortic aneurysm growth is greater or equal to half a centimeter in one year, or ≥.3 cm per year in two consecutive years, or for one year in patients with heritable thoracic aortic disease or those who have a bicuspid aortic valve, surgery may be recommended.

Treatments and research

Among the advantages of having such an experienced team is that if surgery is necessary, there is a full range of options available at Miami Cardiac & Vascular Institute, including open, traditional surgery, and endovascular, or less invasive treatment that uses small incisions.

Procedures offered at the Institute include aortic root replacement, ascending aortic replacement, total arch replacement (TAR), normothermic TAR, thoracoabdominal aortic replacement aortic valve repair, minimally invasive ascending aortic aneurysm repair, and endovascular options for thoracic aortic stent replacement, thoracoabdominal aortic repair (FEVAR), ascending aortic aneurysm or dissection repair, ascending aortic replacement and aortic root repair (Endo-Bentall).

“Cardiothoracic surgery, particularly endovascular surgery, is a relatively new, dynamic and challenging field and one of the reasons I became interested is that there was so much room for innovation,” Dr. Ghoreishi says. He is the co-inventor of the Endo-Bentall device, which combines the concept of a self-expanding valve and a stent graft, allowing patients at high risk for open surgical repair to undergo a less invasive procedure for aortic root repair.

He also developed normothermic total arch replacement and performed Florida’s first case at Miami Cardiac & Vascular Institute. The procedure avoids the need to lower the patient’s body temperature for long periods to stop blood circulation, which not only shortens surgical time by several hours but also lowers the risk of complications.

“We also have clinical trials available and we use several investigational devices. We’ll discuss those with the patient and their family if appropriate,” he says.

Screening and follow-up

If you have risk factors for aortic disease or you’ve been told you have an aneurysm that should be monitored, talk to your cardiologist or primary care physician. Women with aortic disease who are pregnant or contemplating pregnancy also have special concerns. An evaluation at the Center for Aortic Care may be warranted.

There is no standard screening recommendation for aortic aneurysms yet, Dr. Ghoreishi says, but people age 50 and up with risk factors should undergo a chest CT and abdominal ultrasound to rule out an aortic aneurysm. In addition, if you are the sibling or child of someone who has had an aortic aneurysm, you should undergo genetic testing.

“If you have a family history of aortic aneurysms or dissections, it’s critical to get screened as early detection can be lifesaving,” Dr. Ghoreishi says. “The Center for Aortic Care offers comprehensive treatment options to ensure your health and reduce the risk of complications.”