UHealth Launches Comprehensive Aortic Center to Treat the Most Complex Aortic Disease
A new multidisciplinary program brings cardiac and vascular surgeons, cardiologists and genetic specialists together to provide advanced, lifesaving care for aortic aneurysms, dissections and valve disease.
The aorta is the largest and most essential artery, transporting oxygenated blood throughout the body. It’s the heart’s main pipeline to every organ.
“The aorta starts at the aortic valve and goes all the way down to the pelvis,” said Jean Panneton, M.D., a vascular surgeon and co-director of UHealth — University of Miami Health System’s new Comprehensive Aortic Center. “It separates into multiple branches, feeding the brain, the upper and lower extremities, liver, kidneys and so forth. It’s probably the most important organ because it has repercussions on every single part of the body.”
For most people, the aorta performs its essential tasks unnoticed. But if there is a problem, aortic dysfunction can be incredibly dangerous. The Comprehensive Aortic Center was created to provide patient-centered care, assembling cardiac and vascular surgeons, cardiologists, geneticists and others to provide a much-needed resource for people in Miami, South Florida and the Caribbean.
“Miami’s Comprehensive Aortic Center fills a clear void in South Florida,” said Juan Pablo Umaña, M.D., chief of cardiothoracic surgery at UHealth and co-director of the center. “Patients with complex aortic valve issues and aortic disease often had to leave the state to find the care they needed. Not anymore.”
Comprehensive Aortic Center
UHealth offers advanced, multidisciplinary care for patients with complex aortic disease.
A Multidisciplinary Approach to Aortic Disease
The aorta is under constant pressure from the heartbeat. Chronic high blood pressure, connective tissue disorders and congenital valve abnormalities can weaken the aortic wall over time and increase the risk of serious problems, such as aneurysms or aortic dissections.
Sometimes, when the aortic wall weakens, people can get an aneurysm, during which the aorta bulges or becomes enlarged. Aneurysms significantly increase the risk of an aortic rupture or acute dissection, a life-threatening tear in the aorta’s inner layer. If left untreated, the mortality rate for an acute aortic dissection approaches 50% within 48 hours.
“To prevent catastrophic outcomes, rapid diagnosis and immediate surgical treatment are essential,” said cardiothoracic surgeon Ciro Amodio, M.D., co-director of the Comprehensive Aortic Center. “Even in major hospitals, outcomes depend on surgical experience. Having a dedicated team improves survival and patient outcomes.”
Beyond the emergency cases, some people are born with aortic conditions. Approximately 1% to 2% of Americans have a bicuspid aortic valve, which has two leaflets instead of three. This can lead to valve problems and an enlarged aorta. Genetic issues, such as Marfan and Loeys-Dietz syndromes, are associated with higher aneurysm risk and require lifelong monitoring.
As a result, geneticists play a key role in patient care, helping identify the underlying causes of aortic disease. This information can also help family members, who may be at risk for aortic complications, as well.
Advanced Surgical and Minimally Invasive Techniques
The aortic center has recruited a team of experienced surgeons to take on some of the most intricate operations. One of these is the Ross procedure, which transplants a patient’s pulmonary valve to replace a dysfunctional aortic valve.
The procedure was originally developed for children but has since been adapted to adults. It’s particularly relevant for younger patients, who may have this replacement valve for 40 years or more. Synthetic valves have less than half that lifespan.
“The Ross procedure is good for children and young adults because it’s a living valve, which means it adapts and grows,” said Dr. Umaña. “It’s ideal in these situations because it last longer, and it’s the patient’s own tissue, avoiding the need for long-term anticoagulation.”
Repairing Rather Than Replacing Diseased Aortic Valves
Another advance has been repairing, instead of replacing, diseased valves, particularly bicuspid valves.
“Those are usually amenable to repair, and repairing the native valve is always better than replacing it,” said Dr. Umaña. “But it has to be done by a team that understands the anatomy, the concepts and the operative principles behind aortic valve repair for optimal results.”
Until recently, the only way surgeons could repair some acute dissections was through open surgery. Now, new technologies are allowing them to perform these procedures though catheters.
“Open surgery was pretty rough,” said Dr. Panneton. “An acutely dissected aorta is quite fragile, so there was always a great risk of blood loss during these procedures. Now, we have a minimally invasive procedure called a thoracic endograft, inserted at the groin, which protects the aorta. The combination of open and transcatheter techniques into hybrid procedures has led to markedly improved results.”
Expertise in Action: Solving High‑Risk, Complex Cases
This confluence of experience and technology helps aortic center surgeons take on the most challenging cases. In one, a young patient received an aortic valve replacement, only to have it fail after five years. The solution was a Ross procedure.
“We didn’t want to implant a second valve and risk it failing again,” said Dr. Amodio. “The Ross procedure allowed us to use his own pulmonic valve, which could last the rest of his life.”
In another case, a patient with a connective tissue disorder developed a six-centimeter aneurysm following a partial acute dissection repair.
“He had been referred for palliative management because of the complexity of the case,” said Dr. Amodio. “We performed a procedure using a hybrid graft to complete aortic reconstruction in a single stage.”
Expanding Access to Aortic Care in South Florida
The Comprehensive Aortic Center is only a few months old, but it is expanding rapidly. In the coming months, the team will start using a hybrid operating room, which provides advanced imaging during operations to help surgeons navigate through the aorta and it’s many branches.
But surgery is only part of the job. One of the team’s main goals is to educate the public and other clinicians about aortic issues, particularly dissections. Emergency room physicians, for example, can be narrowly focused on whether a patient’s blood vessels are blocked. The team is working to change that mindset.
“We talk to emergency department doctors, cardiologists and others who see patients with chest pain,” says Dr. Amodio. “We tell them, ‘Don’t always assume it’s a heart attack. Think about the aorta, as well.’ An early and accurate diagnosis can save lives.”
As the only aortic center in South Florida, the group feels an obligation to spread the word throughout the region. They are also collaborating with the Marfan Foundation and other patient advocacy groups to ensure the community knows these services are available locally and patients don’t need to travel around the country.
“We’re getting the message out, not just in Miami-Dade, but also Broward and Collier, to bring those patients here,” said Dr. Umaña. “We have unique expertise and technology that we can bring to these problems. We always want to do the right operation, at the right time, the first time around.”
More from the Miller School of Medicine
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.
Dr. Amodio’s brings expertise on complex aortic, thoracoabdominal and endovascular surgeries on the aorta to UHealth and Miami.
The internationally recognized leader in cardiovascular surgery is known for his pioneering contributions to aortic and mitral valve repair.
Tags: aortic valve replacement, Comprehensive Aortic Program, DeWitt Daughtry Family Department of Surgery, Dr. Jean Panneton, Dr. Juan Pablo Umaña, heart disease, minimally invasive aortic valve surgery, thoracic endovascular aortic repair