Complex Aortic Surgery Gives UHealth Patient a Second Chance
After years of complications from an aortic dissection, Red Gonzalez was referred to UHealth—University of Miami Health specialists who developed a staged surgical approach to repair his aorta.
Key Takeaways
- An aortic dissection is a life-threatening tear in the body’s main artery.
- Red Gonzalez needed repairs to both his aortic arch and thoracoabdominal aorta.
- A multidisciplinary UHealth Comprehensive Aortic Care team evaluated the risks and developed a staged surgical approach.
- His treatment included open arch repair, a thoracic stent graft extension and abdominal aortic aneurysm repair.
Red Gonzalez was at high risk for sudden death and never suspected. He wasn’t a smoker or a heavy drinker, experienced no symptoms and had no reason to believe he had a silent, potentially deadly aortic condition. When he found out, he found out suddenly.
“Boom, it hit me hard,” Gonzalez said. “I couldn’t move from the waist down.”
Gonzalez had suffered an aortic dissection, a life-threatening tear in the body’s main artery. Emergency surgery at another hospital saved his life. Doctors temporarily repaired his aorta and gave him a new heart valve, but the operation did not fully solve his problems. For the next two years, he was in and out of the hospital.
The physical and financial toll was devastating. Unable to lift anything heavy, he lost his job as a truck driver and eventually became homeless. For months he lived in a shelter. Gonzalez’s doctors told him there was nothing they could do and advised him to consider hospice care.
Fortunately, he was steered to UHealth—University of Miami Health System.
“It was like day and night,” he said.
Comprehensive Aortic Center
UHealth offers advanced, multidisciplinary care for patients with complex aortic disease.
Comprehensive Aortic Care
Gonzalez was quickly referred to UHealth’s Comprehensive Aortic Center, where a world-class team of cardiac and vascular specialists treat complex aortic conditions. His care was led by cardiac surgeon Ciro Amodio, M.D., and vascular surgeon Jean Panneton, M.D., both co-directors of the center. Together, they bring decades of experience at managing challenging aortic conditions, some deemed inoperable.
The aorta is the body’s largest blood vessel and rises up from the heart like a handle on a cane (the aortic arch). From there, it dives down past the chest to the lower abdomen, feeding oxygenated blood to the body’s organs. Every time the heart beats, the aorta experiences pressure. Sometimes it can bubble out (an aneurysm) or tear (a dissection).
Gonzalez’s case was especially challenging. Both his aortic arch and thoracoabdominal aorta needed repairs. The team carefully reviewed the case before proceeding. Cardiologists, vascular surgeons, anesthesiologists and other specialists debated whether Gonzalez could safely undergo the surgery.
“If the risk is too high, we don’t move forward simply because an operation is possible, but we also don’t give up,” said Dr. Amodio, an associate professor in the DeWitt Daughtry Family Department of Surgery at the University of Miami Miller School of Medicine. “We look carefully at the patient’s entire history, including the surgeries they have already undergone, and evaluate what options may still be available. We want to make sure what we are proposing is both technically feasible and a reasonable risk for the patient.”
The team understood why other doctors had concluded palliative care was Gonzalez’s best option. However, after a careful, multidisciplinary evaluation, they believed there was still a surgical option. Their experience with complex aortic disease allowed them to develop a staged approach to his treatment. Although the procedures were technically challenging and carried significant risks, the team was able to move forward safely.
How the Staged Aortic Repair Worked
Gonzalez needed an open surgery to fully repair his arch and descending thoracic aorta. Using the innovative Thoraflex hybrid graft, Dr. Amodio replaced the diseased aortic arch and incorporated the descending thoracic aorta into the repair, reconnecting the major blood vessels supplying the brain and upper extremities.
“It was my first time doing it at the University of Miami, but I had performed this procedure many times previously,” Dr. Amodio said.
After this open arch repair, he underwent a thoracic stent graft extension and then a large juxtarenal (near the kidney) abdominal aortic aneurysm repair.
“Whenever we work on a patient with a dissected vessel, there’s always increased risk of bleeding, but he actually did quite well,” said Dr. Panneton, professor in the DeWitt Daughtry Family Department of Surgery at the Miller School. “Also, we had to interrupt blood circulation to the kidneys, and there was a risk of putting him into kidney failure. In the end, his kidney function was fine, and he did not bleed much. The next day, he was sitting up in a chair, even after major open aortic surgery.”
Gonzalez brought the same determination to his recovery that his doctors brought to his surgery.
“I wanted to live,” he said. “I wasn’t giving up.”
Today, Gonzalez can feel the difference. His circulation is better, and his blood pressure has dropped. While he still has limitations, he’s learned to adapt. After being told nothing more could be done, he is particularly grateful to his doctors for saving his life.
“It’s all a miracle that I’m still processing,” he said.
More from the Miller School of Medicine
A UHealth surgeon performed the institution’s first complex redo Ross procedure, restoring a heart valve patient’s health, future and hope.
UHealth’s Comprehensive Aortic Program delivers advanced, multidisciplinary care for aortic aneurysms, dissections and valve disease.
Juan Pablo Umaña, M.D. shares the extraordinary journey that shaped his philosophy as a heart surgeon, innovator, and mentor.
The expert in complex aortic reconstruction joins UHealth as the co-director of the UHealth Comprehensive Aortic Center.
Tags: Comprehensive Aortic Center, DeWitt Daughtry Family Department of Surgery, Dr. Ciro Amodio, Dr. Jean Panneton, heart disease, minimally invasive aortic valve surgery