The aortic programme at Royal Brompton & Harefield NHS Foundation Trust manages patients with diseases of the thoracic aorta.
The Trust offers one of the largest aortic programmes, seeing around 90 patients with aneurysms (abnormal swellings) and dissections (tears) coming from across the UK each year. These are the main diseases affecting the thoracic aorta.
Based on a Swedish study from 2006, which looked at 14,000 patients, the prevalence of aneurysms and dissections is around 12 per 100,000 people per year. This figure is growing steadily, largely due to improved rates of diagnosis.
About the programme
The main purpose of the programme is to manage patients with thoracic aortic diseases. The aortic team undertakes approximately 70 operations annually to repair aneurysms and treat dissections. Our surgical team is part of a collaborative emergency service to treat patients suffering acute aortic dissection, which, although rare, can be fatal if the tear in the aorta is not repaired quickly.
In addition, we treat patients who present with combined cardiac and thoraco-abdominal vascular diseases. For example, someone with a long-term chronic cardiac condition, such as pulmonary hypertension or heart failure, who develops an abdominal aortic aneurysm (AAA).
We also treat cardiac (and thoracic) interventional inpatients who develop vascular complications pre- or post-operatively, such as compartment syndrome (where bleeding or swelling occurs within a section or compartment of muscle), at both Royal Brompton and Harefield hospitals.
Other conditions associated with the thoracic aorta are:
- intra-mural haematoma
- penetrating ulcer
- anomalous aortic arch
- complications in adulthood of congenital abnormalities of the great vessels
- trauma, usually blunt and caused by road traffic accidents.
Like many services in the Trust, there is close collaboration with other teams and departments. Most significantly in this instance, with the adult congenital heart disease team, led by Dr Michael Gatzoulis, which is the largest unit of its kind in the UK. A significant number of patients born with a cono-truncal abnormality of the heart and great vessels, who underwent surgery as children, will develop an enlarged aorta in young adult life.
The aortic team at the Trust is actively involved in research in conjunction with the genetics and genomics laboratory and has strong links with the aortic programme at Liverpool Heart and Chest Hospital through the Institute of Cardiovascular Medicine and Science.
The aortic theme seeks to promote clinical research, innovation, postgraduate education and service development between the two trusts.
Acute dissection service
In early 2011, the Trust established a clinical service for acute aortic dissection for NW Thames in collaboration with Hammersmith and St Mary’s hospitals. The service provides a 24-hour on-call rota for earlier and more timely referral of patients with suspected acute dissection, which is caused by a tear in the lining of the aorta allowing blood to enter the aortic wall and causing significant blood loss.
Surgery for acute aortic dissection requires surgeons to use a graft to replace the damaged section of the aortic wall.
The service has led to a significant fall in 30-day mortality for this devastating disease.
For patients with early-stage inherited aortic root disease who are opting for elective surgery, there are three types of surgery available:
- bentall procedure (biological or mechanical)
- valve-sparing aortic root replacement (VSRR)
- personalised external aortic root support (PEARS).
The Trust team is experienced in managing aneurysms of the aortic arch, and the ascending and descending thoracic aorta.
Depending on the patient, we can carry out conventional aortic surgery with modern cerebral perfusion techniques, wire-based deployment of cloth-covered stents, or a combination of both.
Diagnosis and screening
Sometimes a patient may not be aware of their disease, particularly if they show no usual symptoms. Diagnosis can often occur by chance, appearing on X-rays or scans taken for other reasons.
If these patients then choose elective surgery, we will consult with them at least twice before the procedure.
We have a specialised one-stop aortic clinic to inform patients and their families about the implications of this kind of major surgery. Screening other family members, who may also be at risk of disease of inherited and spontaneous genetic defects, is a vital part of this clinic.
Learn more about aortic dissection
Professor Nienaber has contributed on a paper detailing what aortic dissection means, its causes and what surgical interventions are available.
Nienaber, C. A. et al. Aortic dissection. Nat. Rev. Dis. Primers 2, 16053 (2016)