Stony Brook Medicine has opened Suffolk County’s first multidisciplinary Aortic Center—combining the expertise of specialists in vascular surgery, cardiothoracic surgery, cardiology, cardiac imaging, radiology and anesthesiology to provide comprehensive and coordinated care for the full spectrum of conditions affecting the aorta.
The Aortic Center’s extensive experience with minimally invasive interventions permits treatment of a wider range of aortic patients, resulting in shorter hospital stays and fewer postoperative complications. “The creation of the Aortic Center formalizes the longstanding, multidisciplinary teamwork that has made Stony Brook a leader in the treatment of aortic problems, as well as the region’s referral center for complex and high-risk cases,” said Apostolos Tassiopoulos, MD, Professor of Surgery and Chief of the Division of Vascular Surgery and at Stony Brook Medicine. “Our goal is to provide a highly accurate diagnosis of all aortic conditions and treatment plans deploying the most effective, least invasive therapies available.”
“The Aortic Center’s extensive experience with minimally invasive interventions permits treatment of a wider range of aortic patients, resulting in shorter hospital stays and fewer postoperative complications,” said Thomas V. Bilfinger, MD, ScD, Professor of Surgery at Stony Brook Medicine. “As an academic medical center, we are involved in some of the key clinical trials for new aortic procedures and devices. Access to these advances enables us to offer lifesaving options to patients who might otherwise be untreatable because of their age, co-morbid conditions or complex anatomy.”
The aorta is the main artery carrying oxygenated blood from the heart through the chest and abdomen. In addition to blockages, congenital disorders and infection, two of the more common problems affecting this vessel are aortic aneurysms—blood-filled bulges resulting from a weakening in the vessel wall—and aortic dissections, tears in the aorta’s inner wall that can cause reduced blood supply to other parts of the body and cardiac failure. These problems can occur in anyone, but most patients are male, over age 55, smoke tobacco and have high blood pressure or heart disease.
“One of our goals is to educate patients and provide primary care providers with resources that facilitate early recognition of patients at risk, timely diagnosis of aortic conditions that are often silent and medical control of risk factors so that we reduce the number of aortic emergencies in our area,” said Dr. Tassiopoulos.
Treatment options at the Aortic Center range from medical therapy and monitoring for patients with milder conditions to innovative, minimally invasive surgical procedures. Most abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms can be repaired with endovascular techniques using a standard stent graft – a tiny, covered scaffold – to shore up the weakened area. Patients typically go home the next day.
For patients untreatable with a standard stent graft, either because of a complex anatomy or an aneurysm located where the aorta branches off to the kidney, the Aortic Center is the first facility in Suffolk County to offer custom-built, fenestrated endovascular stent grafts. In these cases, surgeons and radiologists develop a complex 3D model of the area requiring repair and a stent graft is custom built to match it.
For some highly complex thoracic aneurysms, the Aortic Center team performs innovative hybrid procedures that combine open surgery and endovascular techniques in order to minimize the magnitude of surgery required. In another recent advance, acute aortic dissections are treated with endovascular stent grafts rather than with the traditional high-risk open surgery. If needed, aortic valve-sparing procedures can repair aortic aneurysms that occur at the aortic root (where the aorta connects to the heart) while preserving the patient’s aortic valve.
The Aortic Center will coordinate patient care using Clinical Navigators, who are assigned to serve as care coordinators from the point of referral through diagnosis, treatment and follow up.
“Our clinical navigators help ensure a seamless experience for patients, their families and the referring physician,” said Dr. Tassiopoulos. “They put patients in touch with the resources and support they need, and act as liaisons between the patient and attending physician before, during and after surgery.” Referring physicians can initiate care at the Aortic Center with a single call and an appointment within one week; emergency transfers are available around-the-clock every day. The center employs a sophisticated database to track the entirety of the patient’s care—lifelong, in many cases—as well as provide alerts for follow-up appointments.