Chapters Transcript Thoracic aortic aneurysm and aortic root repair: Heart care at Mayo Clinic Nandan S. Anavekar, M.B., B.Ch. and Gabor Bagameri, M.D., discuss personalized aortic aneurysmal disease treatment and close collaboration with local care providers. When we think about thoracic erotic Aysal disease as a group, we need to think about three categories. First is genetic etiology. The second is acquired from arthrosclerotic disease and hypertension. And the third is acquired secondary to inflammatory processes. If anybody in their family ever had the history of aortic dissection, aneurysm, they should have a high index of suspicion and they should be probably considered about family screening or further evaluated or the possibility of an aortic aneurysm based upon what we find on genetic testing for those in whom it's indicated, we can give them a better assessment of risk of a certain complication of the erotic disease. And this information I think is critical because it informs the next step. And that next step is when should I have surgery for my erotic enorm disease. So in the last 10 years, there was significant change on our understanding how to treat and manage and what's the underlying cause from the aortic aneurysm disease. We had one size criteria. Usually we use the 5.5 centimeter and surgery was indicated instead of saying that we have to operate in one size 5.5 you know, it's not true because there is a difference between gender, whether the height weight and also in your age. So we can more tailor the treatment options to the patients specifically and the disease, what they have. We have surgeons who have a high volume of surgical procedures under their belt of looking after patients who have aortic diseases. And because of that high volume, our complication rates are really low aortic root replacement surgery. Usually when the aneurysm involves the first part of the aorta, it's called aortic root. It's like you can imagine like a pear shape. It's a very high value real estate because the aortic valve and the coronary arteries sit there most commonly the indication in aros patient, the aneurysm itself, the valve, uh unless you have a bi aortic valve, it's usually not normal and the artist are normal. But in order to replace the aortic root, we have to mobilize. And the question is what to do with the aortic valve. The aortic valve unfortunately, sometimes can be used in bystander replacing the aortic valve. There is no good option. Unfortunately, nothing as good as your own native aortic valve. We can use tissue valve or mechanical valve, but both valve type has a disadvantage advantages. And there is no perfect solution when it comes to more complex cases, especially when it's genetically driven and other organ system are involved. It's always important that we collaborate with other specialties because they need a lifelong care, either prefer surgery and even after the surgery, a key part of managing individuals with uh u aneurysmal disease, that is not quite at the cut off where we would do surgery is surveillance and that in itself can be anxiety provoking. And we understand that to ease that anxiety, we are available 24 7. And if that means a direct phone call from one of our care providers directly to the patient that works. If that means that there is a phone call or an interaction during a consultation locally, we can work to make that happen as well. So we work very closely with the local care providers. We keep them informed about what we're doing, our plan of care and we also keep them abreast of what's new in the field. And I think this level of collaboration only breeds success. Published June 22, 2023 Created by Related Presenters Nandan Anavekar, BCh, MB View full profile Gabor Bagameri Cardiovascular Surgeon View full profile
