Better together

The Libin Cardiovascular Institute’s world-class cardiac surgery program is getting a boost thanks to a new multi-discipline collaboration created to improve patient outcomes.

Four groups—cardiac surgeons, cardiologists, interventional radiologists and vascular surgeons —have joined forces in the past eight months to form the Calgary Aortic Program, coming together both inside and outside of the operating room.

Co-led by cardiac surgeon Dr. Scott McClure, MD, the program, which involves a new clinic, the Calgary Complex Aortic Clinic, based out of the South Health Campus, is an exciting first in Calgary.

“There are many patients that are far better treated if we all get together,” says McClure, estimating about 50 patients annually will benefit from the combined knowledge of the experts. “Some treatment considerations are best approached in a collaborative manner.”

The aorta is the main artery in the body that carries blood away from the heart to the rest of the body. It is made of three parts: the ascending aorta, the aortic arch and the descending aorta, which can be divided into the thoracic and abdominal aorta, providing blood from the upper body down to the pelvis and eventually to the legs.

Surgeries on the ascending aorta, aortic arch and descending aorta within the chest are generally handled by cardiac surgeons whereas surgeries on the abdominal aorta are handled by vascular surgeons.

However, some problems, such as aortic dissections, thoracoabdominal aneurysms and complex aortic arch repairs, are in a grey zone, with discussion needed to determine which surgeon or surgeons—and which methods—would optimize outcomes for these patients.

Beyond surgery there are also less invasive options to consider where patients can be treated less invasively with insertion of a stent into their aorta through the groin. Interventional radiologists, vascular surgeons and cardiac surgeons all have the skills to do these less invasive (endovascular) procedures, but each discipline often has a slightly varied perspective to the problem based on their background training. 

McClure explains bringing the teams together can ensure the best treatment strategy is pursued to benefit the patient, adding the group also hopes to launch research and training components in the future.

Optimizing medical therapies for patients with aortic disease is another major piece to the puzzle.  These patients often require treatment for many years before any surgical or endovascular intervention and for their entire life following the intervention. Cardiologists have a major role to play in this aspect of the patients care.

Led by McClure, vascular surgeon Dr. Randy Moore, MD, interventional radiologist Dr. Eric Herget, MD, and cardiologist Dr. Michelle Keir, MD, the program is off to a great start.

Herget, whose skills lie in using radiology tools like imaging and ultrasound to perform minimally invasive endovascular procedures, has been supportive of a collaboration for years. 

“Aortic disease includes abdominal and thoracic work, so there is a crossover in expertise,” he says. “Having all of the disciplines involved is very positive, because it ensures we have all of the anatomical areas covered.” 

Vascular surgeon Dr. Kenton Rommens, whose expertise lies in complex aortic repair and advanced thoracic surgery, explains that the best centres in the world have collaborative programs, adding the group will also have access to cutting-edge techniques and devices. 

“I think it is an important step for the treatment of these patients,” he says. “Our goal is to turn Calgary into a referral site known for being world leaders in our approach.”

Keir says long-term, multidisciplinary care has never been more as Calgary cardiologists are meeting an increasing number of impacted families thanks to advancements in genetic testing and imaging.

She says having the opportunity to ask questions and discuss cases in real time with her colleagues as part of the Calgary Aortic Program will help her treat patients more efficiently and effectively.

“This collaboration between specialties is really exciting,” says Keir. “It’s a win for the patients, it’s also a win for clinicians as it will act as a springboard for research and quality improvement.”