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Why should you receive treatment
at the AMC Aortic Disease Center?

Blood is pumped out of the heart to the rest of the body through a pipe-like structure called an aorta. Various diseases may occur in the aorta, a structure that is constituted by a thick tube that extends from the heart, through the chest, and to the abdomen. The incidence of aortic diseases is on a rapid rise due to the trend of increasing risk factors for arteriosclerosis such as longer life spans and lifestyle changes; it is especially present in those aged 70 years or older.

AMC’s Aortic Disease Center produced world-class achievements after the introduction of the multidisciplinary treatment system for aortic diseases such as aortic aneurysms, aortic dissections, and aortic stenosis. The center also offers the most optimal and individualized treatment for each patient including conventional and minimally-invasive surgeries, percutaneous procedures, and hybrid surgeries that combine surgical and procedural techniques. In particular, patients requiring surgery and percutaneous procedures receive treatment in a hybrid operating room - a state-of-the-art medical facility - where various treatments that previously required multiple visits are carried out altogether in a single place, minimizing the patient’s exposure to risk and providing optimal treatment.

The Aortic Disease Center operates a 24-hour cardiovascular surgery hotline that enables emergency surgery for more efficient medical treatment. One-stop treatment services for patients with aortic dissection and traumatic aortic rupture provides fast diagnosis and advancement to surgery.

Treatment options

Lifestyle improvement and drug therapy

Given that the development of aortic aneurysms is related to risk factors such as lifestyle, hypertension, etc., it is beneficial for patients to avoid meat and to change to a low-salt diet mainly composed of vegetables and fish. It is important that patients with hypertension strictly maintain a normal blood pressure through additional drug therapy.

Surgery

Surgery or procedure is strongly recommended in patients who have aortic aneurysms larger than 5~5.5cm even if there are no symptoms. This is due to the high possibility of rupture, which is fatal. In the past, patients have avoided thoracic aorta surgery due to its high mortality rate and brain-related complications and cultural stigma. Surgeries including the aortic arch were difficult as it took 6~10 hours to complete and required patients to maintain hypothermia (less than 18℃) to sustain cerebral blood flow, even with the use of cardiopulmonary bypass machines. However recent advancements in surgical techniques during the past decade made way for more efficient surgical strategies in many qualified high-volume centers, significantly reducing mortality rates and complications. Since 2012, AMC individualized aortic arch surgeries depending on extent and pursued operational strategies that maximized safety and efficiency. The total operation time minimized to 2 hours and 10 minutes with an average of a groundbreaking 3 hours and 50 minutes. The amount of time for total aortic arch replacement also reduced to 2 hours and 30 minutes with an average of 4 hours and 40 minutes. Thus, the time for aortic arch surgery became similar to that of other heart surgeries. Furthermore, the success rate of non-emergency surgery was 100%, and that of emergency surgery was 94% with no permanent brain complications. These results represented the safety of aortic arch surgery.

Stenting

Recently stenting, a method in which a stent is inserted into to the aorta without surgery, is in the spotlight to treat aortic diseases. It is accepted as a procedure that has the same success rate as surgery but also reduces surgery related complications particularly in well-selected patients who have descending aorta diseases. However, inserting a stent may cause other complications. Therefore, it is most important to receive expert guidance when deciding between “surgery” and “stenting.”

Transcatheter aortic valve replacement (TAVR)

The prevalence of aortic valve stenosis is known to be directly associated with age. Aortic valve replacement is recommended for patients who have severe symptomatic aortic valve stenosis. In patients without symptoms, surgery is proposed in those who have severe coronary artery diseases or depressed left ventricular functions. However, despite the advancement of surgical techniques and a decline in pre- and postoperative mortality, one-third of patients cannot receive surgery due to the increased risks caused by old age and accompanying diseases. Also, drug therapy or percutaneous balloon valvuloplasty is reported not to be helpful in these patients. Furthermore, the need and demand for TAVR as an alternative intervention in elderly patients who have aortic valve stenosis is increasing, for they cannot receive open heart surgery due to high-risk factors and accompanying diseases.

TAVR is an approach that involves the insertion of a balloon that extends from the femoral vessel to the aortic valve. There, the balloon is inserted between the narrowed valves and inflated to install a mesh that functions just like the valve. The procedure was clinically tested for safety and effectiveness and was officially recognized as a new medical technology by the Ministry of Health and Welfare. TAVR is highly valued, especially in that it serves as a new treatment method in elderly patients who have aortic valve stenosis. In 2010, AMC first introduced the TAVR in Korea. Since then, the center performs 35% of all TAVR procedures with a 97% success rate.

AMC’s treatment performance

Major surgeries and procedures / performance

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Name Performance Remarks
TAVI 300(accumulated) The largest number performed in a single institution
in Asia, 34.6%
Aortic disease surgery 250/year  
Emergency aorta operations (rupture, dissection) 50/year  

Major medical facilities

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Devices Unit
Cardiac Surgery ICU (CSICU) 15
Hybrid OR 1