Revolutionizing Treatment of Aortic Aneurysms

Aortic dissection- a tear in your aorta-  is a life threatening event, and if it occurs in the arch of the aorta, the surgery to fix it requires full circulatory arrest rather than standard bypass surgery.  This surgery is associated with very high mortality and a high rate of complications, extended hospitalizations and prolonged recovery.  Dr David Planer from our division has worked to develop a new stent graft to fix these dissections in this crucial and anatomically challenging part of the aorta.  Working with the Israeli start-up Endospan, Dr Planer is part of the team who developed and tested the “Nexus,” a newly developed stent graft system that can be implanted in the cath lab.  Using new 3 D technology and multiple careful steps, this procedure may revolutionize the care of these patients.

This modular procedure includes two separate units that together reconstruct the aortic arch.  A ”through and through” guidewire is inserted into the patient’s body through the groin artery extending to the artery that supplies the arm.  The first implant is then threaded in its closed form to the proper position in the aorta, extending from the innominate artery which supplies the right arm and the right brain, into the arch. It is then carefully opened by the operator. Once this section is in place, the second section of the implant is transported and implanted in the remainder of the arch, overlapping the first implant– completing reconstructing of the arch. All blood flow is then directed through the implants, excluding the diseased area of the aorta.  This then protects the patient from rupture.

The procedure is so complex and the anatomy of the aorta in this region is so challenging that the team developed an innovative approach to preparing for the implantation.  An exact replica of the patient’s aortic arch as determined by CT scanning is printed on a three-dimensional printer; the surgical team conducts a full simulation of the procedure from start to finish on this printed version of the arch.

The Nexus system has, to date, been implanted in 50 patients worldwide.  Dr. Planer has been part of the surgical team in each procedure. Recently, it has been implanted in Hadassah patient, an 84 year old gentleman with pre-ruptured aortic aneurysm. The procedure was conducted in the new Heart Center hybrid cath-lab, by our team, headed by Dr. Planer and co-developer Dr. Lachat in cooperation with Prof. Oz Shapira and Dr. Amit Korach of Hadassah’s Cardiothoracic team.  

This procedure is a major advance in the treatment of life-threatening aortic aneurysms, and we congratulate Dr. Planer on his pivotal role in this notable advance in the field.

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