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Francis Caputo, MD discusses aortic ruptures from autolaunch presentation to repair and disposition.

Enjoy the full Tall RoundsĀ® & earn free CME

  • Critical Care Transport: ED Presentation - Permissive Hypotension: Michael Phelan, MD
  • Admission, Bedside Risk Stratification and OR Prep: Ann Gage, MD
  • Case Presentation - In the OR: Abdominal Aortic Rupture, open or EVAR?: Sungho Lim, MD
  • Postop Admission to ICU and Step-down Unit: Steven Insler, DO
  • Physical Therapy and Discharge for Convalescence: Marsha Thompson, MSN, APN
  • Literature Review and Future Endeavors: Francis Caputo, MD

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Talking Tall Rounds®: Aortic Ruptures

Podcast Transcript

Announcer:

Welcome to the Talking Tall Rounds series, brought to you by the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic.

Francis Caputo, MD:

So I will get my Micro Machines voice out and tell you everything you need to know about aortic ruptures, process and everything.

Francis Caputo, MD:

One thing that has been entailed today is the process, right? And it all starts with a team. So much like the movie Invictus portrays the 1995 South African rugby team underdogs that took the World Cup, it's all about the team and not necessarily about the player, right? Just ask Los Angeles.

Francis Caputo, MD:

So there is a deluge of medicine that shows high volume centers do better, and that is the main reason why versus anything else that they do better in terms of outcomes and mortality and morbidity with ruptured and acute aortic syndromes. In fact, there's a paper from our center that is starting to try to decipher why they do better. And that's what we're trying to do.

Francis Caputo, MD:

And what you've heard today is, from the auto-launch to the discharge, is we are a team, right? We have wonderful multidisciplinary in terms of the clinicians, ER, cardiothoracic, vascular, but we also have the other ancillary services. And it's really about the team here.

Francis Caputo, MD:

So what do high volume centers do better, right? We try to figure this out.

Francis Caputo, MD:

So we can recognize different pathologies, right? We have the infected aorta that not everyone can necessarily recognize. And we've actually seen two of these in the last couple weeks versus the gas around the aorta with the previous repair, versus your bland, just simple ruptured aneurysm. However, these are all different pathologies and they all have to be handled differently.

Francis Caputo, MD:

But also, we have the expertise, and we showed this here today, to deal with these patients preoperatively. We have a unique system in terms of controlling these patients with J31, as well as the ER. And there's a deluge of research trying to look at whether hypotension and all this stuff works, and nothing has really been picked up and shows to make a difference. However, we implement the current guidelines that all our societies recommend to the fullest degree. And that is one thing that we should applaud.

Francis Caputo, MD:

What else do we do? We are a unique set of individuals here in terms of cardiothoracic and vascular, and not to toot our own horns, but for the majority of us, and all of us, we have the unique expertise to do both open and endovascular repair, consult with our cardiac colleagues, consult with other people, and figure out whether or not the patient is best served with an open versus an endo procedure.

Francis Caputo, MD:

Yes, endo is better, and that's been showing in literature over and over, but only if you can actually fix the patient. You know, you're throwing a square peg into a round hole. You're not going to necessarily fix that patient. You're going to have still a ruptured aneurysm you're dealing with.

Francis Caputo, MD:

And what else do we do better? We heard about in the ICU, we talked about resuscitation and post-operative care. We have the ability to do massive transfusion protocol, product replacement, aggressive transfusion, aggressive resuscitation, and not afraid to leave the bellies open and deal with the sequela of a ruptured aneurysm.

Francis Caputo, MD:

And what we know is, this is all recent, is that open AAA mortality is strongly correlated with volume, right? So that has been multiple, multiple seen, as well as, higher volume, there's lower risk. And we talk about this constantly at the Clinic, is it's not anything other than, at these centers, that we do so well is the ability to rescue. So even if our patients have problems, we have the ability to rescue.

Francis Caputo, MD:

What separates most outstanding facilities and tertiary care centers from those that are a little bit grade below is the ability to rescue these patients when they have problems.

Francis Caputo, MD:

So how do we spread this gospel? How do we spread the Cleveland Clinic way? So as we have today seen, we have a unique situation in process from door to door; we have a multidisciplinary assessment.

Francis Caputo, MD:

Currently we, as a multidisciplinary group, are trying to research and figure out why our patients do so well. You know, we have the volume, we have a unique setting, but furthermore, are we able to present this research and do this research, and once we gather the information, how do we demonstrate our process to other centers for similar survival benefits? How do we promote this?

Francis Caputo, MD:

I think that is the key. We have it here, guys. You guys all look to your left and to your right; we are outstanding. We should all be very proud of ourselves. We have outstanding radiology techs, we have outstanding nursing, we have outstanding doctors, we have outstanding nutritionists. We have everything that we have here, and that's why our process works.

Francis Caputo, MD:

But how do we figure out why it's working, what's working that's really making the benefit, and how do we promote it to other centers?

Announcer:

Thank you for listening. We hope you enjoyed the podcast. Like what you heard? Visit Tall Rounds online at clevelandclinic.org/tallrounds, and subscribe for free access to more education on the go.

Cardiac Consult
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Cardiac Consult

A Cleveland Clinic podcast exploring heart, vascular and thoracic topics of interest to healthcare providers: medical and surgical treatments, diagnostic testing, medical conditions, and research, technology and practice issues.

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