Patients with aortic disease can face a complex healthcare journey that requires sophisticated care — and in the case of a ruptured aortic aneurysm or dissection — emergency treatment. With the launch of the Center for Aortic Care at Baptist Health Miami Cardiac & Vascular Institute, a multidisciplinary team is available to work with you and your patients 24/7.

“Our new center for aortic care is dedicated to providing patients the highest level of expertise and innovative treatments for aortic conditions,” said 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.”

Institute physicians follow the newest clinical Aortic Disease Guidelines developed by the American Heart Association and the American College of Cardiology. 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 like the Institute’s that use shared decision-making in treatment planning.

The best outcomes occur in the hands of extremely experienced and specialized physicians, said 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.

“At the Center for Aortic Care, we can provide treatment for a problem anywhere in the aorta’s 11 segments,” he said. “There aren’t many centers in the country that can provide this level of care for aortic disease.”

The multidisciplinary team includes cardiac surgeons, vascular surgeons, interventional radiologists, cardiologists, hypertensive cardiologists, cardiac imaging specialists, anesthesiologists and genetic consultants.

Physicians and advanced practice providers (APPs), including those in primary or family care, cardiology or internal medicine — as well as emergency medicine physicians and APPs and EMTs — need to be aware of the guideline changes for aortic disease.

In the past, surgeons usually recommended watchful waiting and close 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 catastrophic emergency,” Dr. Ghoreishi said. “For appropriate patients with smaller aneurysms and a low risk of complication, surgery, whether it’s open or endovascular, 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.”

The new guidelines

Among the new guidelines:

• The threshold for surgical intervention for sporadic aortic root and ascending aortic aneurysms has been lowered from 5.5 cm to 5.0 cm in selected patients. In certain scenarios and for patients with heritable thoracic aneurysms, intervention may be advised for even smaller aneurysms.
• The definition of rapid aortic root growth or ascending aortic aneurysm growth, an indication for intervention, is ?0.5 cm in one year or ?0.3 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.
• It’s important to follow the recommended approaches for CT, MRI and echocardiographic image acquisition, measurement and reporting of relevant aortic dimensions, as well as those for the frequency of surveillance before and after intervention.
• For significantly smaller or taller than average patients, surgical thresholds may incorporate indexing of the aortic root or ascending aortic diameter to either patient body surface area or height, or aortic cross-sectional area to patient height.
• Clinical trials are suggesting that endovascular repair may be an option for patients with thoracoabdominal aortic aneurysms with suitable anatomy.
• Aortic imaging screening is recommended for first-degree relatives of patients with aneurysms of the aortic root or ascending aorta, or those with aortic dissection.

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).

Dr. Ghoreishi 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 said.

Dr. Ghoreishi recommends that people age 50 and up with risk factors undergo a chest CT and abdominal ultrasound to rule out an aortic aneurysm. In addition, if you have patients who are the sibling or child of someone who has had an aortic aneurysm, you should suggest they undergo genetic testing.

Physicians at the Center for Aortic Care partner with referring providers and value collaborative communication. For more information, or to refer a patient, contact us at 786-596-1230.