2022 Aorta Center Results

Podcast Transcript

Announcer:

Welcome to Cleveland Clinic Cardiac Consult, brought to you by the Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Eric Roselli, MD:

Once again, we're the largest aorta center in the country. I think Dr. Svensson points it out pretty regularly that our volume is bigger than all the centers in Houston combined, which is quite a feat. That's where a lot of that surgery originated. We are innovating as well. You can see that about a quarter of these operations are emergencies. Shout out to Marijan Koprivanac for always being available to make sure these operations get taken right away, and to the whole team. We heard a remarkable story in the last week or two about how Dr. Unai, who's still an important part of the Aorta Center, even though he doesn't take that call, just happened to be strolling by as a patient was dying. The whole team rallied in the way that we always do, in the way that no one else can, to save a young life. Those are those stories that make us the proudest. Even though we do it 1100 times a year, each patient is really important to every one of us, and that's what makes us special and allows us to achieve outcomes like this.

Again, just as you heard from the last speakers, our observed outcomes are a third of what's expected. What's expected, that comparison group is not just STS data, it's University Health Consortium, so big centers, big multicenter experiences, places that tout themselves to be aorta centers, and we do better. We do better than all of them, and I'm proud to say that we're the best.

Let's look at what we do. We have deep roots. When we talk about the aorta, it runs through our whole torso. The first part, the aortic root, is often considered one of the most complex areas to operate. We did 591 of those in 2022, including 63 homografts, a lot of Bentall procedures, 112 reimplantations, and we continue to do Ross procedures in adults and adolescents, not just in kids. If you look at this volume of a hundred, it said 112 in the last slide, 112 reimplantations, this is a very important operation, a specialized kind of operation, that's not offered anywhere, and our outcomes are amazing.

If you look at the mortality from root replacement, it's 0.8 percent, emergencies t's less than 6 percent. That's a large volume, 124 emergency root replacements. If you look at the STS database, the average for elective root replacement, the mortality is 2.7 percent. That's quite a remarkable difference about what we do, and it actually represents about 10 percent of the volume in the whole country. So, this is an important part of our work, and not only at the root and through the ascending aorta, but another complex part of the aorta where we do remarkably well and have a huge volume of surgery is in the aortic arch. A large-volume center will do maybe five arch replacements a year. We did 133 in 2022, and we do it in novel ways.

This physician-sponsored IDE, the B-SAFER, and thank you all for so many of the participants, our co-investigators, has now enrolled over 200 patients, and we're going to ask for approval from the FDA to add another hundred patients to that. The mortality has been around 4 percent. That includes a third of these patients being acute type A dissections, and the disabling stroke rate of less than 2 percent is also about a fifth of what's often described in other large-volume centers. The work that we're doing has driven an industry partner to work with us to develop a device based on our patent, and hopefully we'll begin the pivotal study next year. We've also been involved in some other new studies, this AMDS study. We've enrolled a couple of patients. Dr. Vargo's the PI here for that. We're involved with several other investigational devices to do endovascular arch replacement. Every one of these novel devices represents some element of the future, and we're helping to define that.

As we work our way down the end of the line through the aorta, we still do a large volume of thoracoabdominal aneurysm repairs. There are only a few centers doing more than a handful of these. In 2022, we did nearly 50 of them. I show these images because we're seeing more often that these operations are involving a previous placed stent graft. This year we used the first of these devices. I think the company may call it the Roselli graft, I'm not sure. I'll allow them to do so. We used data from our series of patients undergoing these kind of complex hybrid operations to help design this surgical graft, which can facilitate that complex reconstruction of various devices.

We're also involved in new technology to expand the future in how we treat the ascending aorta with endovascular devices. We led the early feasibility study. We've used these devices in novel ways, like you see up on the right, for some patients who had no other options. It's really changed our treatment paradigm. It's not just done you have to go to surgery or not when you show up with a dissection? We now consider these ascending devices as part of our therapy. Coming soon, we'll be beginning the pivotal study ARISE 2. I'm the national PI and Dr. Vargo is the principal investigator here on campus. I'm sure we'll be the highest enroller in that.

Not only touching patients every day, one at a time, we share our knowledge so that other people can hopefully achieve some of the results that we have. Members of the Aorta Center are involved in 343 publications, close to a hundred of those were purely dedicated to the aorta across the whole spectrum, from basic science to industry-sponsored papers and outcome studies, and we're involved in the guidelines as well. We've had many educational events, both hands-on events where we've brought alumni back here, and we'll be having this CLE: Comprehensive, Lifelong, Expeditious, Care of Aortic Disease Symposium in the fall, on National Aortic Awareness Day. I hope some of you can join us for that.

We've been involved with patient community outreach. We raised over 50,000 dollars for the Marfan Foundation, we've been involved with social media to educate the world, and we will continue to touch lives by taking care of their aortas and their great vessels every day, thanks to every single one of you. Thanks for helping us save lives every day.

Announcer:

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