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Devices and Collaboration to Treat Aortic Disease

Care at the Smidt Heart Institute doesn’t stop at the heart. Our experts routinely manage cases ranging from acute dissections to chronic aneurysms of the aorta. Leading the way in clinical trials, novel devices and minimally invasive care, the collaborative team at the Smidt Heart Institute at Cedars-Sinai is reimagining aortic care.

Eduardo cooking on the mountain top

PROGRAM DIFFERENTIATORS

• Early consultation and seamless collaboration between referring physicians and surgeons
• Experts in complex treatment, including open and endovascular aortic repair
• Leaders in clinical trials and investigational devices, including branched devices for the aortic arch and thoracoabdominal aorta
• Advanced imaging techniques to evaluate the implications of aneurysms in individual patients
• A holistic approach to aneurysm management throughout the lifespan, including skilled care during pregnancy and nonaortic surgeries as well as lifestyle and genetic counseling
• Recognized by the Marfan Foundation as a center with expertise in the comprehensive care of individuals with genetic aortic and vascular conditions

SERVICE SPOTLIGHTS

• Experts in minimally invasive (endovascular) aortic repair, including ascending, arch and thoracoabdominal aortic repair; endovascular aneurysm repair; thoracic endovascular aortic repair; and fenestrated endovascular aortic repair for minimally invasive aortic aneurysm and dissection management
• Comprehensive management of aortic aneurysms, dissections, transections, infections, inflammatory disorders, connective tissue diseases, and ulcers and fistulas
• Expertise in the Ross procedure, valve-sparing root replacement and aortic valve repair

the case

Eduardo Grande (39) is a Marfan syndrome patient with prior mechanical Bentall and ascending arch replacement, open infrarenal abdominal aortic aneurysm repair, open arch repair with innominate and left common carotid debranching, and elephant trunk. He presented with an 8.3-centimeter thoracoabdominal aortic aneurysm.

the care

Eduardo’s cardiac and vascular surgeons collaborated perioperatively on a staged hybrid repair of the extent II thoracoabdominal aneurysm. They performed a left carotid–subclavian artery bypass, coiled the left subclavian artery and repaired the proximal thoracic aorta using minimally invasive thoracic endovascular aortic repair (zones 2-5). Then, they performed an open extent IV thoracoabdominal aortic aneurysm repair, using left-heart bypass with sequential clamping and individual anastomosis.

the conclusion

Eduardo returned home nine days after the procedure. Two months after surgery, he had returned to most of his daily activities, including fixing his Jeep, cooking, camping and off-roading with family and friends.