Baptist Health Miami Cardiac & Vascular Institute has taken yet another leading role nationally in surgical advances with the first “aortic arch” replacement in Florida without the long-standing and riskier practice of lowering the patient’s body temperature to temporarily stop the flow of blood. 

The landmark surgery – a normothermic “total arch replacement” (TAR) -- was performed by Mehrdad Ghoreishi, M.D.

Normothermic means having a normal body temperature – about 98.6 degrees (F). Dr. Ghoreishi has performed the most normothermic TAR surgeries in the U.S. More than 100 of the procedures have been performed in France and other parts of Europe. The aortic arch is a vital segment of the aorta, the body’s largest artery that helps distribute blood to the head and upper extremities. The arch sits over the heart between the ascending and descending aorta.

Dr. Ghoreishi has revolutionized surgical treatments of the aorta while co-director for the Center for Aortic Disease at the University of Maryland Medical System, where he first developed normothermic TAR. He joined Miami Cardiac & Vascular Institute earlier this year. For years, the Institute has taken a leading role in national clinical trials that have led to pivotal advances in treating or replacing heart valves and improving outcomes of other cardiovascular therapies and procedures.

Lower Risk of Complications, Faster Recoveries

“With the evolution of new techniques in aortic procedures, we can do these complex operations safely with low-risk of complications and low risk of mortality,” explains Dr. Ghoreishi. “An aortic arch operation for aortic aneurysm or dissection was considered a very high-risk operation. Now, with the new surgical techniques and devices (stents), we can treat these patients much safer.”

The normothermic TAR surgery at Miami Cardiac & Vascular Institute was performed on a 77-year-old woman who is recovering well. She arrived at the Institute in critical condition with a descending aortic dissection, a life-threatening condition that occurs when blood breaks through the outer layer of the aorta, causing a tear in the descending aorta. For the surgery, Dr. Ghoreishi used the Thoraflex Hybrid device, developed for open-heart surgery to repair or replace damaged or diseased sections of the aortic arch. Dr. Ghoreishi has modified the use of the device for normothermic TAR.

“She’s a small lady who would not tolerate being in the operating room for seven or eight hours,” explains Dr. Ghoreishi. “She underwent the normothermic total arch replacement, and the whole operation took about three hours. What was formally a seven- or eight-hour operation, or a whole day event, now takes about three hours. While we were perfusing her brain, we stopped the perfusion to the body for just seven minutes to implant this device (Thoraflex Hybrid). This short period of circulatory arrest, allows us to stay warm and, therefore, be able to perform the operation in a short period of time.”

Vital Advantages of Normothermic Surgery

Until Dr. Ghoreishi’s landmark procedure, total aortic arch replacements required lowering the patient’s body temperature – to as low as 20 degrees Celsius (68 degrees Fahrenheit) – to slow down cellular activity and allow blood circulation to be stopped for up to 40 minutes. The complete surgery usually takes six to seven hours.

However, normothermic TAR only requires about six to seven minutes of circulatory arrest without lowering body temperature – and a total of three to four hours of surgery. Recovery usually entails five to ten days in the hospital. After that, it takes about one month for patients to recover fully from this operation and resume normal, active lives, said Dr. Ghoreishi.

“Dr. Ghoreishi has joined our team of highly skilled and experienced clinicians as an innovator in groundbreaking aortic surgeries,” said Tom C. Nguyen, M.D., director of Minimally Invasive Valve Surgery, Chief Medical Executive and Barry T. Katzen Medical Director Endowed Chair of Baptist Health Miami Cardiac & Vascular Institute. “He has already advanced quality patient care with the Institute’s first normothermic total arch replacement and other surgeries he has developed to lower risk of complications and significantly improve outcomes.”

National Clinical Study to Focus on Normothermic TAR Outcomes

Dr. Ghoreishi is highly skilled in both open surgery and minimally invasive, catheter-based treatments of aortic disease, including endovascular treatment of the ascending aorta, aortic arch and aortic root. He has the most experience in the U.S. in the performance of normothermic aortic operations, as well as endovascular aortic arch and aortic root repair.

“Because aortic surgery has evolved, both open surgery and endovascular (minimally invasive) operations at the Institute can be offered for patients safely, with a lower risk of stroke and a lower risk of mortality,” said Dr. Ghoreishi.

He is now about to take the lead in a national clinical study at the Institute comparing outcomes of the normothermic TAR procedure with results of the traditional total arch replacements with the much more time-consuming surgeries and the lowering of a patient’s body temperature. As the aging population in the U.S. grows, the prevalence of aortic disease, which may lead to aneurysms or worse, is increasing. Risk factors include age, smoking, high blood pressure, the buildup of plaques in the arteries, a family history or certain genetic conditions.

“Patients with strong risk factors -- like smoking history, older age (65 and older), family history of aortic aneurysm, atherosclerosis of cardiovascular disease, hypertension, hyperlipidemia, patients with bicuspid aortic valve, and patients with inherited connective tissue disorder -- should be screened with abdominal ultrasound and a chest CT scan to make sure they don’t have an aortic aneurysm,” explains Dr. Ghoreishi, who urges everyone with these risk factors to consult with their primary care physician and cardiologist. “When it's necessary, aortic surgery in an elective setting for aortic aneurysm is very safe. If we wait for an aneurysm to rupture or to tear, the risk of an operation in an emergency setting is remarkably higher.”