New Aortic Center

Use of Neuromonitoring during Aortic Surgery and Hybrid Surgical Techniques for Complex Cases

While complex aortic diseases have been treated for many years at the University of Maryland Medical Center, the opening of the Center for Aortic Diseases adds a new cohesiveness to existing multidisciplinary teamwork, hybrid surgical techniques and advanced technology that will continue to draw the toughest aortic disease cases from around the region.

Officially opened on July 1, the Center for Aortic Diseases incorporates the skills and technologies of heart and vascular specialties to offer streamlined “one-stop shopping” to often-fragile aortic disease patients, says cardiac surgeon Teng Lee, M.D., co-director of the Center for Aortic Diseases and assistant professor of surgery at the University of Maryland School of Medicine. Vascular surgeon Robert Crawford, M.D., also serves as co-director. Instead of various specialists seeing patients in different locations, the center includes a multidisciplinary clinic to facilitate coordinated care by physicians.

“There’s almost an epidemic of aortic disease in this region,” explains Dr. Lee. “Hypertension is the real reason behind the high numbers of aortic disease,” adds cardiologist Wallace Johnson, M.D., medical director of the Center and assistant professor of medicine. He continues, “Much of our work will be focused on preventive care as well as management of patients. With the increased use of CT scans, more aortic disease is found now than in the past. If we can catch it early, we can treat it.”

Another crucial aspect of the new center is its link to the Critical Care Resuscitation Unit (CCRU), which has been developed to enhance the medical center’s capacity to accept the most critically ill adult patients. “The Aortic Center is a great resource for the community and immediate access to its services for patients with life-threatening aortic disease is crucial,” explains Lewis Rubinson, M.D., Director, Critical Care Resuscitation Unit.

He adds, “This Center is a prime example of why the medical center must have greater capacity to accept critically ill adult patients from other facilities. The CCRU is a novel approach that ensures bed capacity issues are no longer a barrier. Critically ill patients with aortic disease will have life-saving care at the medical center.”

Comprehensive treatments for aortic disease

A wide variety of specialists staff the Center for Aortic Diseases, including those in cardiology, cardiac surgery, vascular surgery, internal medicine, critical care, imaging and anesthesia. Just as vast is the list of conditions treated here, such as aortic aneurysms, aortic dissections, aortic valve disease, connective tissue disorders such as Marfan syndrome, and hypertension related to aneurysm or dissection.

Treatments and services cover the spectrum from genetic and aortic disease screenings to long-term medical management, hypertension management and cardiovascular follow-up. “Cardiogenetics availability extends our understanding of the disease etiology and process and allows thoughtful, directed family screening,” explains Stacy Fisher, M.D., assistant professor of medicine and pediatrics. Among the surgical approaches are open and/or endovascular procedures — which for diagnostic and/or interventional purposes can be performed simultaneously in the center’s three “hybrid” operating rooms — along with percutaneous and transcatheter valve therapies or minimally invasive surgery.

“We do the most advanced therapies of any center in this region,” says Dr. Lee, who is certified in performing complex arch repairs with combined endovascular and open technology. In addition, he also serves as lead surgeon for the transcatheter heart valve program. “The other unique thing about us is that we’re one of only a few centers on the East coast that do neuromonitoring during procedures ... to avert problems or complications.”

Neuromonitoring avoids complications

Neuromonitoring involves the use of electroencephalograms (EEGs) and motor and sensory evoked potentials to monitor the brain and spinal cord during thoracic and abdominal aortic surgeries. “With neuromonitoring, we can lower the incidence of stroke and paraplegia,” he explains. Unlike at most other hospitals, Dr. Lee does antegrade brain perfusion during Type A dissection repair to decrease stroke risk.

The center’s hybrid ORs also house advanced on-table CT scanners to confirm exact blood vessel location during procedures. “There are only between 100 and 200 of these machines in the country, and our center has five of them,” Dr. Lee says. “Because of this accuracy, we can treat sicker patients because we can decrease the amount of contrast used, so even patients with kidney disease can benefit.”

This comprehensive level of offerings draws patients from a five-state radius and brings referring physicians peace of mind, according to Dr. Crawford, an assistant professor in the Division of Vascular Surgery.

“It’s very difficult for practitioners in the community to spend so many resources on one patient. We have that capability — we’re built for this,” Dr. Crawford says. “There is no pressure to see more and more people, so if I have to spend more time with one patient, I can do that. Because of the complexity of aortic diseases, there’s a commitment to the patient that’s unique and can only be provided at a place like this with all of our resources.”

Innovative research

Complementing the Aortic Center’s aggressive clinical efforts are a host of high-profile clinical trials and research initiatives that allow physicians to expand their knowledge of aortic disease. UMMC is the only center in the Baltimore-D.C. area, and one of only about 30 in the country, included in the STABLE II trial to treat patients with aortic dissection with the newest dissection-specific stent device, Dr. Crawford says. Another major study funded by the National Institutes of Health is analyzing the antibiotic doxycycline as a medication to potentially decrease the growth rate of abdominal aortic aneurysms.

“It’s the only trial of its nature using a pharmaceutical agent for the treatment of aortic disease, and all 30 national centers chosen for this are leaders in aortic disease,” he adds.

Adding to the Aortic Center’s accolades is UMMC’s distinction as one of 35 centers in the world participating in the International Registry of Acute Aortic Dissections (IRAD). “Established in 1996, IRAD is a consortium of research centers that are evaluating the current management and outcomes of acute aortic dissection, and information derived from the registry will aid in patient diagnosis and treatment,” explains Dr. Lee, who is also the principal investigator at University of Maryland.

“We are used to complicated patients as that’s the nature of the game here,” Dr. Crawford says. “Rarely do patients see only one set of eyes. When you come to the University of Maryland, you’re going to get multiple physician perspectives. Plus we have the infrastructure, the ICUs, crucial care nursing care, the latest technology in the OR, access to these research devices ... all the newest and latest.”

To refer a patient for consultation to the Center for Aortic Diseases, please call 1-800-373-4111. For an urgent transfer, please call University of Maryland ExpressCare at 410-328-1234.

This page was last updated: February 4, 2014

         
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