Aorta Center

Overview

The aorta is the body’s main artery that carries blood from the heart to the rest of the body. The section of the aorta that starts with the aortic valve in the heart and goes to the diaphragm is called the thoracic aorta. The part of the aorta that extends from the diaphragm through the abdomen is called the abdominal aorta.

The aorta can become damaged and weak, causing it to become wider (aneurysm) or torn (dissection). It can also, in rare cases, become blocked (stenosis or occlusion). These problems increase your risk of having a life-threatening event. Damage to your aorta can be caused by an injury or certain diseases and health conditions. These include:

• Atherosclerosis ("hardening of the arteries").
• Medial degeneration.
• Hypertension (high blood pressure).
• Genetic conditions (such as Marfan Syndrome).
• Other connective tissue disorders (such as Ehlers-Danlos Syndrome, Loeys-Dietz Syndrome, bicuspid aortic valve disease, osteogenesis imperfecta, polycystic kidney disease and Turner Syndrome) and inflammatory and autoimmune diseases (such as aortitis).

Many patients with thoracic aorta conditions also have problems with the aortic valve. This requires having the aortic valve repaired or replaced at the same time the problem with the thoracic aorta is corrected. Patients with abdominal aorta conditions may also have problems with the blood vessels that are attached to the aorta and need additional treatment.

The Centers for Disease Control and Prevention estimates that more than 43,000 patients die each year from aortic diseases. If you have an aortic disease, it is important to be treated by an experienced team of cardiovascular specialists and surgeons.

Connective tissue provides support to many structures within the body, such as the heart valves, blood vessels (the aorta), eyes, bones, nervous system and lungs; therefore, patients with connective tissue disorders require a multi-disciplinary approach to their care and long-term follow-up.

The mission of the Aorta Center is to bring together a knowledgeable and experienced multidisciplinary team of cardiology and vascular doctors and surgeons and other experts to provide:

• A thorough evaluation of patients using state-of-the art diagnostic testing.
• Ongoing comprehensive care of patients with disease of the aorta, connective tissue disorder and Marfan Syndrome.
• Genetic screening for families of patients with genetic disorders.
• Ongoing research and education to provide patients with high quality and innovative therapies.

Resources

1. Svensson, LG, Rodriguez ER. "Aortic organ disease epidemic, and why do balloons pop?" Editorial, Circulation. 2005 Aug 23; 112(8): 1082-1084.
2. Svensson LG, Blackstone EH, Cosgrove DM 3rd. "Surgical options in young adults with aortic valve disease". Curr Probl Cardiol. 2003 Jul; 28(7): 417-80.
3. Svensson, Lars G. and E. Stanley Crawford. "Cardiovascular and vascular disease of the aorta". W.B. Saunders Company, Philadelphia (1997).

Recent Important Publications and Reports

• Vivacqua A, Albacker TB, Roselli EE. Hybrid thoracoabdominal aneurysm repair with antegrade visceral debranching from the ascending aorta: concomitant cardiac surgery and stent-grafting. Ann Thorac Surg. 2011 Dec; 92(6): 2275-7.
• Roselli EE, Sepulveda E, Pujara AC, Idrees J, Nowicki E. Distal landing zone open fenestration facilitates endovascular elephant trunk completion and false lumen thrombosis. Ann Thorac Surg. 2011 Dec; 92(6): 2078-84.
• Lima B, Roselli EE, Soltesz EG, Johnston DR, Pujara AC, Idrees J, Svensson LG. Modified and "Reverse" Frozen Elephant Trunk Repairs for Extensive Disease and Complications After Stent Grafting. Ann Thorac Surg. 2011 Nov 14. [Epub ahead of print]
• Goel SS, Tuzcu EM, Agarwal S, Aksoy O, Krishnaswamy A, Griffin BP, Svensson LG, Kapadia SR. Comparison of ascending aortic size in patients with severe bicuspid aortic valve stenosis treated with versus without a statin drug. Am J Cardiol. 2011 Nov 15; 108(10): 1458-62.
• Reynolds MR, Magnuson EA, Lei Y, Leon MB, Smith CR, Svensson LG, Webb JG, Babaliaros VC, Bowers BS, Fearon WF, Herrmann HC, Kapadia S, Kodali SK, Makkar RR, Pichard AD, Cohen DJ; Placement of Aortic Transcatheter Valves (PARTNER) Investigators. Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis. Circulation. 2011 Nov 1; 124(18): 1964-72. Epub 2011 Oct 3.
• Svensson LG, Kim KH, Blackstone EH, Rajeswaran J, Gillinov AM, Mihaljevic T, Griffin BP, Grimm R, Stewart WJ, Hammer DF, Lytle BW. Bicuspid aortic valve surgery with proactive ascending aorta repair. J Thorac Cardiovasc Surg. 2011 Sep; 142(3): 622-9, 629.e1-3.
• Pettersson GB, Subramanian S, Flynn M, Nowicki ER, Batizy LH, Svensson LG, Blackstone EH. Reoperations after the ross procedure in adults: towards autograft-sparing/Ross reversal. J Heart Valve Dis. 2011 Jul; 20(4): 425-32.
• Oderich GS, Greenberg RK. Endovascular Iliac Branch Devices for Iliac Aneurysms. Perspect Vasc Surg Endovasc Ther. 2011 Aug 1. [Epub ahead of print]
• Jenkins MP, Haulon S, Greenberg RK, Forbes TL. Debate regarding the best surgical option for type IV thoracoabdominal aortic aneurysms. J Vasc Surg. 2011 Jul; 54(1): 258-67.
• Qureshi MA, Martin Z, Greenberg RK. Endovascular management of patients with Takayasu arteritis: stents versus stent grafts. Semin Vasc Surg. 2011 Mar; 24(1): 44-52. doi: 10.1053/j.semvascsurg.2011.04.002.
• Haulon S, Greenberg RK. Part Two: Treatment of type IV thoracoabdominal aneurysms--fenestrated stent-graft repair is now the best option. Eur J Vasc Endovasc Surg. 2011 Jul; 42(1): 4-8. No abstract available.
• Svensson LG, Batizy LH, Blackstone EH, Gillinov AM, Moon MC, D'Agostino RS, Nadolny EM, Stewart WJ, Griffin BP, Hammer DF, Grimm R, Lytle BW. Results of matching valve and root repair to aortic valve and root pathology. J Thorac Cardiovasc Surg. 2011 Dec; 142(6): 1491-1498.e7. Epub 2011 Jun 17.
• Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ; PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011 Jun 9; 364(23): 2187-98. Epub 2011 Jun 5.
• More Publications

What We Treat

The Aorta Center is made up of a multidisciplinary group of specialists in cardiology, cardiac surgery, vascular medicine, vascular surgery, cardiothoracic anesthesia, cardiovascular imaging, genetics, ophthalmology and orthopaedic surgery. These clinicians provide expertise in genetic and diagnostic testing, medical management and surgical and endovascular procedures, and are dedicated to provide care to patients with all types of aortic disease. These include:

• Thoracic aortic aneurysm.
• Abdominal aortic aneurysm.
• Aortic valve disease that involves the aortic root such as bicuspid aortic valve disease.
• Aortic dissection.

Our Cardiovascular Marfan Syndrome & Connective Tissue Clinic provides specialized care for patients with:

• Marfan Syndrome.
• Connective Tissue Disorders affecting the aorta, such as Ehlers-Danlos Syndrome, bicuspid aortic valve disease, osteogenesis imperfecta, polycystic kidney disease and Turner Syndrome.
• Inflammatory and/or autoimmune diseases of the aorta such as aortitis.

Because of our breadth and scope of expertise we are able to offer a full range of treatments. Our surgeons are experienced in techniques that involve the aortic root, aortic valve and the most complex procedures involving the entire aorta and branch arteries.

• Thoracic Aorta, Aortic Root, Aortic Valve, Ascending Aorta Surgery.
  • Minimally invasive “keyhole” Bicuspid Aortic Valve Repair and Ascending Aortic Surgery.
  • Valve Sparing or Valve Preserving Surgery (Reimplantation Surgery).
  • Endovascular Repair of Thoracic Aortic Aneurysms.
  • Aortic Valve Surgery, when required with aorta surgery.
  • Percutaneous and Minimally Invasive Aortic Valve Surgery.
• Descending and Abdominal Aorta surgery.      
  • Abdominal Aortic Aneurysm – Traditional Approach.
  • Abdominal Aortic Aneurysm – Endovascular Stent, including fenestrated grafts.
• Aorta Surgery affecting different areas of the aorta, the entire aorta or the attached blood vessels: Complex Aorta Surgery , including branch grafts.
• Heart surgery for Marfan Syndrome.
  • Heart Surgery for Marfan Syndrome – Valve Sparing or Valve Preserving (Reimplantation) method (Actual surgery photos).

Why choose Cleveland Clinic for your care?

Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don't hesitate to ask.

Cleveland Clinic performs approximately 1,200 aorta operations each year, 900 on the thoracic aorta and some 1,500 aortic valve procedures. Our heart surgeons perform 300 – 400 heart operations each year.

Our Team

Collaboration among heart and vascular doctors, surgeons, diagnosticians and other medical specialists allows us to provide each patient with a thorough evaluation, follow-up and treatments to meet their individual needs.

• Eric Roselli, MD, Cardiac Surgery Director, Aorta Center
• Milind Desai, MD, Cardiology Director, Aorta Center
• Francis Caputo, MD, Vascular Surgery Director, Aorta Center

Our Medical Team

* Physicians with an asterisk (*) by their name specialize in treating patients with Marfan disease and connective tissue disorders

Surgical Team

Thoracic and Cardiovascular Surgery

• Faisal Bakaeen, MD
• Haytham Elgharably, MD
• Marijan Koprivanac, MD
• Xiaoying Lou, MD
• Eric Roselli, MD*
• Edward Soltesz, MD
• Lars Svensson, MD, PhD*
• Michael Zhen-Yu Tong, MD
• Shinya Unai, MD
• Patrick Vargo, MD

Vascular Surgery

• Ravi Ambani, MD *
• Francis Caputo, MD *
• Ali Khalifeh, MD
• Lee Kirksey, MD
• Sean Lyden, MD *
• Jon Quatromoni, MD

Cleveland Clinic vascular surgeons perform both traditional and endograft aorta surgery.

Cardiothoracic Anesthesia

• John Apostolakis, MD
• Andrew Bauer, MD

Pediatric & Congenital Heart Surgery

• Hani Najm, MD, Chair of Pediatric and Congenital Heart Surgery
• Tara Karamlou, MD

Clinical Team

Tomsich Family Department of Cardiovascular Medicine

Section of Cardiovascular Imaging

• Milind Desai, MD
• Brian Griffin, MD
• Richard Grimm, DO*
• Christine Jellis, MD, PhD
• Vidyasagar Kalahasti, MD*
• Zoran Popovic, MD, PhD
• Jay Ramchand, MD, PhD
• Leonardo Rodriguez, MD
• Maran Thamilarasan, MD*
• Tom Wang, MD
• Bo Xu, MD

Clinical Cardiology

• Ajay Bhargava, MD
• Donald Hammer, MD*
• Venu Menon, MD
• Neha Quatromoni, MD
• Heba Wassif, MD, MPH

Vascular Medicine

• Jay Bishop, MD
• Scott Cameron, MD, PhD
• Natalia Fendrikova-Mahlay, MD
• Marcelo Gomes, MD
• Deborah Hornacek, MD
• Geoffrey Ouma, DO
• Ammar Saati, MD
• Teresa Wu, MD

Pediatric Cardiology

• Ken Zahka, MD*

Advanced Imaging Team (CT and MRI)

• Michael Bolen, MD, Section of Cardiovascular Imaging, Imaging Institute
• Paul Schoenhagen, MD, Section of Cardiovascular Imaging, Imaging Institute

Basic Science

• Scott Cameron, MD
• David Van Wagoner, PhD

Cardiovascular Clinical Genetics

• Diane Clements, MS, CGC
• Christina Rigelsky, MS, CGC

Ophthalmology

• Elias Traboulsi, MD*

Orthopedic Surgery

• Ryan Goodwin, MD*
• Thomas Kuivila, MD*

Rheumatic & Immunologic Disease

• Carol Langford, MD, MHS, FACP*
• Alexandra Villa-Forte, MD, MPH

Quantitative Sciences

• Ashley Lowry, MS

Appointments

What to Expect

Whether you are coming from around the corner or around the world, you want to know what to expect before, during and after your visit with us. If you have any questions while reviewing this information, please contact us. We are happy to answer any questions you may have.

Becoming a Patient by Discipline

Due to the nature of aorta disease, your needs as a patient can guide your care. For example, you may want to have regular follow-up over a long period of time, or maybe you have just been diagnosed with aorta disease and need to establish a care and treatment plan. Perhaps you are exploring treatment options and need a surgery consultation. We can also help if you have Marfan syndrome or a connective tissue disorder and need a comprehensive treatment plan. No matter what your needs, we are here for you every step of the way. If you have any questions please do not hesitate to call.

General Information - Aorta Center

By Phone

Department of Cardiovascular Medicine
216.444.6697 or toll-free 800.223.2273, ext. 46697

Department of Cardiothoracic Surgery
toll-free 866.289.6911

Department of Vascular Surgery
216.444.4508 or toll-free 800.223.2273, ext. 44508

Directions

Cleveland Clinic is located at:
9500 Euclid Avenue
Cleveland, OH 44195

Your appointment will be scheduled in the Miller Family Heart, Vascular & Thoracic Institute (J or F Building).

When you make your appointment, ask for your physician’s name and desk number.

You may find the following links helpful:

• Door-to-door/valet directions
• Door-to-garage directions
• Travel Guide

If you have trouble finding your physician’s desk once you arrive at Cleveland Clinic, you can ask any of our Red Coats for directions. They are happy to help.

Online

Use our secure online form to submit an appointment request 24/7. We will receive it and follow-up with you as soon as possible.

• Submit an online request

Online Second Opinions

Use our secure online form to submit an online second opinion request.

• Submit an online second opinion request

Physician Referrals

Mon. - Fri., 8 a.m. - 5 p.m. (ET):
toll-free 800.659.7822

• More info on referrals, transfers and critical care transport.

At all other times, call Patient Access Services locally 216.444.8302 or toll-free 800.553.5056

Clinical Team Appointments

If your scheduled appointment is at least one week away, you will be asked to send in a copy of your medical records, including a medical history, test results and films (echocardiogram, ultrasound, chest X-ray, MRI, CT). All information should be sent in the same package (clearly marked with your name and address) via Airborne Express, Federal Express, or certified U.S. mail (make sure you have a tracking number) to the physician you will be seeing at Cleveland Clinic. Your appointment may be with Vascular Medicine (Desk J3 - 5), Cardiovascular Imaging (Desk J1 - 5) or Clinical Cardiology (Desk J2 - 4), depending on your condition and needs.

The address to mail your records is:

Physician Name
Cleveland Clinic
Desk # 
9500 Euclid Avenue
Cleveland, OH 44195

If your scheduled appointment is less than one week away, please bring your records to your appointment.

Traveling to Cleveland Clinic

To help make your visit to Cleveland Clinic as easy as possible, please visit:
Information on travel to the Miller Family Heart, Vascular & Thoracic Institute.

What to expect during your appointment

Your appointment will begin by meeting with a nurse or physician assistant (PA) who will collect information about your medical history, symptoms and test results, and enter your information into our electronic medical record. This will help the doctor during your exam.

You may need blood and imaging tests, such as an electrocardiogram, echocardiogram, MRI or CT scan. The specialists in the Aorta Center will use these tests to help diagnosis your condition or create an individualized treatment plan for you. A cardiologist from the Aorta Center will review your records, take a medical history, perform a physical exam, and, if needed, consult with other physicians in the Aorta Center to discuss your condition. If you need to meet with one of the multidisciplinary specialists, they will be consulted and we hope to arrange a meeting with them within a day to limit travel to and from Cleveland Clinic. The Aorta Center cardiologist will talk to you about your diagnosis and plan of care within 1 to 2 days, depending on when your test results are completed.

How long will you need to stay at Cleveland Clinic?

You should plan on spending 1 to 2 days in the Cleveland area. Your stay may be longer if a treatment is scheduled at the time of your visit.

Follow-up

Your doctor will talk to you about your plan for follow-up care.

Cardiovascular Surgery Team Appointments

If you would like information about your surgical options for your aorta disease, you can send your medical records in for a review. The process involves several steps:

• Contact the Heart, Vascular & Thoracic Institute Resource Nurses, who will collect information such as your contact information and the type of surgery you need.
• The nurses will give you a list of the information needed to complete the surgical review and tell you how to send in your information.
• You will send in your records to be reviewed by one of our surgeons.
• The surgeon’s office will call you to let you know about your surgical options. The process generally takes a couple weeks once we receive your films, unless your physician determines that there is an urgent need for surgery.
• If you decide to have surgery at Cleveland Clinic, you will be given a surgery date.

What to expect during your appointment

You will need to arrive a few days before your surgery to have a full evaluation and meet your surgical team. You and your family will attend a program to prepare you for what to expect before, during and after your surgery. See Heart Surgery at Cleveland Clinic for more information about having surgery at Cleveland Clinic.

How long will you need to stay at Cleveland Clinic?

Your hospital stay depends on many factors, such as your condition, the type of surgery you need and your medical history. Generally, patients who live outside of the Cleveland area come to Cleveland a day or two prior to surgery, stay in the hospital 5 to 7 days, and stay in Cleveland at least one night after leaving the hospital before traveling home. We ask that you return to Cleveland Clinic for a post-op visit during the first week after you leave the hospital, so you may want to plan on staying in the area until after that visit.

Follow-up

Your doctor will talk to you about your plan for follow-up care.

Vascular Surgery Appointments

If your scheduled appointment is at least one week away, you will be asked to send in a copy of your medical records, including a medical history, test results and films (echocardiogram, ultrasound, chest X-ray, MRI, CT). All information should be sent in the same package (clearly marked with your name and address) via Airborne Express, Federal Express, or certified US mail (make sure you have a tracking number) to the physician you will be seeing at Cleveland Clinic.

The address to mail your records is:

Surgeon Name
Cleveland Clinic
Desk F - 30
9500 Euclid Avenue
Cleveland, OH 44195

If your scheduled appointment is less than one week away, please bring your records to your appointment.

Traveling to Cleveland Clinic

To help make your visit to Cleveland Clinic as easy as possible, please visit:
Information on travel to the Miller Family Heart, Vascular & Thoracic Institute.

What to expect during your appointment

Your appointment will begin by meeting with a nurse or physician assistant (PA) who will collect information about your medical history, symptoms and test results, and enter your information into our electronic medical record. This will help the doctor during your exam.

You may need blood and imaging tests, such as an MRI or CT scan. The specialists in the Aorta Center will use these tests to help diagnose your condition or create an individualized treatment plan for you.

A vascular surgeon from the Aorta Center will review your records, take a medical history, perform a physical exam, and, if needed, consult with other physicians in the Aorta Center to discuss your condition. If you need to meet with one of the multidisciplinary specialists, we will try to arrange a meeting with them within a day to limit your travel to and from Cleveland Clinic.

The Aorta Center vascular surgeon will talk to you about your diagnosis and plan of care within 1 to 2 days, depending on when your test results are completed.

How long will you need to stay at Cleveland Clinic?

You should plan on spending 1 to 2 days in the Cleveland area. Your stay may be longer if a treatment is scheduled at the time of your visit.

If you need to have vascular surgery at the time of your visit, the amount of time you spend in the hospital will depend on many factors, such as your condition, the type of surgery you need and your medical history. Generally, patients who live outside of the Cleveland area come to Cleveland a day before their surgery, stay in the hospital 3 to 7 days, and stay in Cleveland at least one night after leaving the hospital before traveling home.

Follow-up

Your doctor will talk to you about your plan for follow-up care.

Research

For Patients

Cleveland Clinic Heart, Vascular & Thoracic Institute physicians, surgeons, and researchers continue to research into new treatments and therapies with the goal of improving patient care and outcomes into the future.

• More information on Heart, Vascular & Thoracic Institute Research

Clinical Trials

Clinical trials (or research studies) help us create the medicine of tomorrow. They provide hope through offering testing of new drugs, new surgical techniques or other treatments before they are widely available.

We can help you access hundreds of clinical trials across all specialty areas. Our new searchable online trials tool makes identifying treatment opportunities easier than ever.

Condition & Treatment Videos

Video Listing

• Does Your Aorta Need Surgery? -  Dr. Patrick Vargo
• The Surgeons Who Care for Your Aorta - Drs. Caputo and Vargo
• Does Your Aortic Aneurysm Need Surgery - Drs Caputo and Lyden
• Ask the Heart Doctor: Aorta Disease Part 1
• Ask the Heart Doctor: Aorta Disease Part 2
• Genetic Testing for Aortic Disease: Should You be Tested?
• Aortic Aneurysm: What is it and how is it treated? - Drs. Roselli and Svensson
• Aneurysm with Marfan syndrome: Reoperation with Elephant Trunk Insertion
• Minimally Invasive Repair of Aortic Valve and Root Aneurysm - Dr. Lars Svensson

Aorta Condition & Treatment Videos

The links to the videos below highlight questions and answers about aorta disease, aortic aneurysms and treatments by our medical professionals.

• View the Aorta Disease Videos
• Aorta Disease, Aortic Aneurysm Treatments

Whiteboard Videos

White Board Videos - Aorta