Aorta Surgery Updates and Outcomes

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.

Patrick Vargo, MD:

Hello, everybody, and thank you for joining us and allowing me to talk about the Great Vessel program in the Aortic Center that we have here at Cleveland Clinic and our experience over the last year.

 Again, looking back through the data for 2024, we've increased the aortic volume at the center here. That's not just any one particular part of the aorta, but the entire aorta as a whole, joining with our colleagues in vascular surgery. We use an array of different strategies to repair the aorta and replace the aorta, from endovascular, minimally invasive, conventional open, and a hybrid of all of them combined. We’re up to 1,650 cases last year.

If you look just at the thoracic aorta in the chest, that was over 1,300 operations and the majority of them elective, but still with 17% of our operations being emergent and higher risk in nature. Looking at our outcomes from all these operations, we observed a 0.8% mortality with these high-volume, complex operations. That's much less than the expected 2.5% that you would ordinarily see with these kinds of operations.

In 2024, we had 771 root operations, root replacements. That includes: 467 Bentall’s, where we replaced the root and the valve; 64 homografts using donated, human tissue to replace the aortic root and the valve, oftentimes for very complicated endocarditis or complex redo situations; 210 valve sparing root replacements and valve reimplantations; and 30 Ross operations, harvesting the pulmonary autograft and moving it to the aortic position.

Our mortality for these 771 operations is 0.8% in the elective situations and 5.7% in the emergency situations. I think the majority of these emergency operations were type A dissections or very, very ill patients with an expected very high mortality. When we looked at our data going out, elective root replacements, aortic valve reimplantation, 2.5%, so very low.

Looking especially at the aortic valve reimplantation and saving the living human valve, this volume has increased year over year. In 2024, we had over 200 operations where we reimplanted the aortic valve into a synthetic aortic root, treating aneurysmal disease and often valve regurgitation. And we do it very well. When we looked at our data, we’re at 90% freedom from reoperation at 12 years. So these are durable repairs.

We continue to do many, many arch operations. These are often quite extensive, illustrated by the elephant trunk procedure, where we replace the entire arch and also leave a graft down in the descending aorta for later-stage procedures. Last year we did 132, consistent with last year's volume as well. The way we're doing these continues to evolve.

An update from our B-SAFER study, a physician-sponsored study led by our own Dr. Roselli, innovating a new way to replace the aorta more extensively with excellent results. We're up to 421 patients and counting enrolled in this study in just a few years. 45% of these patients, nearly half of these patients, were acute type A dissections. The overall mortality for this entire group, which is very high risk, is 5%.

In addition, we're continuing to advance new devices and hybrid solutions in these patients. AMDS just finished its trial we participated in. Now we have it available for us to use as well in dissections, oftentimes acute. Dr. Koprivanac has used them as recently as a week ago.

We also have a growing experience with these branch stented endografts. This is an entirely endovascular repair of an aortic arch aneurysm and descending aortic aneurysm. We are publishing our data, which is among the most that’s been used since it's become commercially available, and the data was presented at the European meeting, EACTS . Additionally, we’re participating in the ARISE II trial using ascending stent grafting for chronic ascending pathology. We are currently the highest enrolling site of this multi-site trial. There's already talks to begin the next phase of it, the ARISE III trial for acute type A dissections.

You see here, completely treated endovascular repair of the ascending, descending, arch, thoracic aorta there, in the 3D reconstituted imaging there. And that's the stent right there, the ascending stent graft, that is what this trial is investigating.

But we have other trials going along the way as well. We participated in the Duett vascular graft anastomosis trial. They've submitted some of their results, and we'll see if we'll continue with that. There are new trials coming online, such as the Artizen trial to trial the Arcevo device to again, improve the way we replace arches and thoracic aortic disease.

The hard work of everybody in the aortic center was recognized this year at the Marfan Foundation. Aortic directors were able to receive an award presented there. We continue to fundraise and to advocate for aortic diseases with the Marfan’s Walk, and raised over $50,000 last year with over 350 participants. We continue to try and share what we know and educate our colleagues and partners to improve cardiovascular care and aortic care by hosting root courses.

This year, we will again host our biennial aortic disease conference, CLE (Comprehensive Lifelong Expeditious) Care here at the Cleveland Clinic in the Aortic Awareness Disease Week in September. Thank you.

Announcer:

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