2017 Outcomes Report for Cardiovascular Services

Aortic Disease

 

NewYork-Presbyterian’s open heart and endovascular surgery programs for aortic disease continue to grow as international and nationally recognized centers of excellence. These programs bring together the expertise of comprehensive care teams with advanced treatment algorithms that result in excellent outcomes for aortic disease. At the same time, we are expanding clinical and translational research efforts in all areas of adult cardiac and vascular surgery, with a major focus on aortic surgery. Drawing on an extensive aortic surgery database, our physicians are addressing aortic pathologies and procedures using complex statistical analyses with a goal toward durable outcomes.

Preserving the Native Aortic Valve

Through the collaboration of cardiothoracic surgeons, cardiologists, and cardiovascular radiologists, we are seeking to transform care for ascending aortic aneurysms that will enable preservation of a patient’s native valve. The use of a new imaging method – four-dimensional flow MRI and computational fluid dynamics – is being explored to visualize and analyze flow dynamics that will help guide surgery to alleviate stress on the repaired aortic valve. This, in turn, will reduce the incidence of late aortic events, including new aneurysms, tears, and dissections.

Two major research projects are underway at Weill Cornell investigating the flow dynamics in the aortic root after valve-sparing operations using 4-D MRI, computational dynamics, and sophisticated in vitro simulators. These investigations, in collaboration with colleagues in Rome, will help identify the optimal surgical technique for recreating normal physiology.

Biological Solutions to Aortic Root Replacement

Weill Cornell surgeons recently published early and mid-term results of a study comparing valve-sparing surgery to root replacement with a biologic composite conduit in a series of 749 patients. They found that both approaches provide excellent outcomes. However, at mid-term follow-up the use of a biologic composite conduit is associated with a higher risk of reoperation.

Endovascular Advances

At NewYork-Presbyterian, our endovascular specialists, who are experts in catheter and wire-based techniques, obtain the best possible outcomes for patients with aortic aneurysms, complicated Type B dissections, and aortic coarctation. Many endovascular aortic repairs are performed completely percutaneously with no incisions.

Aortic Procedures

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Open Thoracic Aortic Repair

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Cornell International Consortium for Research in Aortic Surgery

This international network of highvolume aortic centers utilizes blinded external analysis of data by a dedicated group of experts for outcome analysis. Additional studies utilize a multidisciplinary approach to analyze and optimize aortic disease surgery in collaboration with cardiac surgeons, cardiologists, radiologists, bioengineers, and basic scientists.

Endovascular Thoracoabdominal Aneurysm Repair

Weill Cornell vascular surgeons are using fenestrated and branched endograft technology to offer lessinvasive treatments for patients with thoracoabdominal aortic aneurysms that involve the visceral vessels of the aorta. Through this physician-sponsored IDE clinical trial, custom-designed endografts are used for an individualized approach tailored to each patient’s anatomy.

Frozen Elephant Trunk Technique

Weill Cornell faculty are participating in a multicenter clinical trial evaluating the frozen elephant trunk technique for complex aortic disease. This hybrid technique is a single-stage surgery combining endovascular treatment with conventional surgery using a hybrid prosthesis to treat disease of both the aortic arch and the descending thoracic aorta – traditionally a two-stage surgery.

Genetics of Marfan’s Syndrome

A recent grant from the National Marfan Foundation will help to establish a two-year fellowship to study the genetic predisposition of aneurysm formation in patients with Marfan’s syndrome. The curriculum – to be conducted at Weill Cornell and with scientists in Milan, Italy – will incorporate the fields of cardiology, cardiac surgery, and mechanical engineering.

Endovascular Procedures

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Endovascular Abdominal Aortic Repair

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