Eight years ago, UCSF vascular surgeon Timothy Chuter, M.D., designed and pioneered the use of branched stent grafts to treat thoracoabdominal aneurysms. He is now leading clinical trials to establish the efficacy of the devices, and is finding them to be "extraordinarily durable." Similar branched technology allows vascular surgeons to apply minimally invasive techniques in the aortic arch. These interventions at sites close to the heart require an evolving collaboration with cardiac surgeons.
"The aortic arch presents real challenges for endovascular technique—challenges which have already been met by cardiac surgeons using conventional open surgery techniques, such as a bypass pump," says Chuter. "They understand the pathology and the locale, where we understand the technology and the mechanics and the human response to this technology."
The UCSF Heart and Vascular Center also offers the latest technology in the treatment of aneurysms and dissections throughout the aorta. The center conducts a number of ongoing trials investigating minimally invasive treatments for thoracoabdominal aortic aneurysms and abdominal aortic aneurysms. When treating aneurysms close to the heart, such as in the aortic arch or aortic root, vascular surgeons collaborate with cardiothoracic surgeons and referring cardiologists to design individual plans for optimal outcomes.
Cardiac and vascular surgeons also work together to perform hybrid operations on aortic aneurysms close to the heart, combining both open surgical and endovascular interventional approaches. Cardiac surgeons open the patient's chest and reroute blood flow to the brain through bypass grafts; then, vascular surgeons introduce the stent graft to reline the weakened artery.
"The benefit of the hybrid approach is that we can use the stent graft to treat the aortic arch aneurysm without the hypothermic circulatory arrest component," says vascular surgeon Darren Schneider, M.D. "By marrying the open surgical technique with the endovascular device technology, we can reduce the magnitude and the morbidity of the operation."
"The sooner the cardiologist refers the patient, the better," says Scot Merrick, M.D., UCSF director of cardiothoracic surgery. "The biggest issue is making sure that referring physicians know what the technology can do, and not to wait until the patients get so sick that the technology can't help them."
In the future, both cardiac and vascular surgeons hope to take this collaboration to the next level. Cardiothoracic surgeon Elaine Tseng, M.D., conducts research with vascular surgeons to improve therapies for structural heart diseases, particularly aortic valve disease, using less invasive endovascular devices.
"I work with vascular surgeons and interventional cardiologists to further therapies for structural heart disease," says Tseng. "In the next few years, mitral valve repairs and aortic valve replacements will be done through a transcatheter approach for high-risk patients."
To contact Timothy Chuter, M.D., call (415) 353-4366.
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