Emerging Treatments for Complex Aortic Disease at University Hospitals Harrington Heart & Vascular Institute

Innovations in Cardiovascular Medicine & Surgery | March 2025

University Hospitals (UH) Harrington Heart & Vascular Institute treats the full spectrum of aortic disease, including innovative endovascular techniques for the most complex aortic anatomy.

William J. Yoon, MD, PhD

Cristian Baeza, MD

Multibranch aortic aneurysm repair involves the use of advanced endografts to treat aneurysms that affect major arterial branches. William J. Yoon, MD, PhD, Co-Director of the Aortic Center at UH Harrington Heart & Vascular Institute and a clinical associate professor at Case Western Reserve University School of Medicine, has expertise in the treatment of complex aortic diseases using branched and fenestrated endografts. He successfully performed the first four-vessel fenestrated endovascular aortic repair at UH Harrington Heart & Vascular Institute.

“Fenestrated and branched endografts allow incorporation of aortic side branches and preservation of end-organ perfusion while achieving aneurysm exclusion with a total endovascular approach,” Dr. Yoon says. “UH Harrington Heart & Vascular Institute is offering these revolutionary techniques that promise to significantly improve outcomes for our patients with complex aneurysm disease and position our center as a leading destination for state-of-the-art aortic care.”

GORE® EXCLUDER® Thoracoabdominal Branch Endoprostheses (TAMBE)

The U.S. Food and Drug Administration (FDA) approved TAMBE in 2024 as a life-saving option for patients with thoracoabdominal and pararenal aortic aneurysms. TAMBE is the first off-the-shelf endovascular repair solution for the treatment of complex aneurysmal disease involving the visceral aorta.

“Until now, endovascular treatment options for these complex aneurysms were limited as alternatives to open surgical repair because these aneurysms frequently span adjacent visceral arteries,” Dr. Yoon says. “TAMBE has four built-in, pre-cannulated internal portals to facilitate placement of bridging stent grafts into the visceral arteries perfusing the internal organs within the abdomen.” Because the system is fully contained, it can be used in urgent cases, enabling surgeons to provide effective and timely care for emergent complex aneurysm repair.

ARTIVION™ AMDS™ Hybrid Prosthesis

The UH Harrington Heart & Vascular Institute has been selected to treat patients with ARTIVION’s AMDS Hybrid Prosthesis, the world’s first aortic arch remodeling device for the treatment of acute DeBakey Type 1 aortic dissection. The system has FDA approval through a Humanitarian Device Exemption.

“Acute DeBakey Type I dissection is a life-threatening medical condition that requires immediate surgical repair,” says Cristian Baeza, MD, Co-Director of the Aortic Center at UH Harrington Heart & Vascular Institute and a clinical associate professor at Case Western Reserve University School of Medicine.. He explains that the long-held standard of care for this condition has been an ascending aorta replacement or hemiarch repair. While this procedure can successfully remove the primary entry tear, it fails to adequately address the remainder of the dissected aorta and can result in complications like acute mal-perfusion and long-term aneurysm formation. “In the PERSEVERE IDE trial, AMDS has shown resolution of mal-perfusion and promotion of positive aortic remodeling, thereby reducing the risk of long-term aneurysm formation,” says Dr. Baeza.

Current International Trial

Evaluating the Hemodynamic Performance of Endografts

UH Harrington Heart & Vascular Institute in Cleveland is the primary site — and Dr. Yoon is the principal investigator — for a study of the hemodynamic performance of endografts. The multi-institutional project, entitled Evaluating the hemodynamic performance of endografts for zone 0 aortic arch repair: a computational study, began in 2024. Collaborating academic medical centers include the University of Massachusetts, University of Texas Southwestern, University of Southern California, University of California, Davis, and Uppsala University (Sweden).

Dr. Yoon presented the team’s primary findings at the February 2025 Critical Issues America meeting. “The performance of these new branched endografts garnered much interest in the vascular surgery community, resulting in expansion of participating institutions and bringing the project to new heights,” he says. “I believe we can push the aortic endografting field for complex aortic cases much further by working together.”

International Registry of Acute Aortic Dissection (IRAD)

UH Harrington Heart & Vascular Institute in Cleveland has been accepted into IRAD, a consortium of research centers evaluating the current management and outcomes of acute aortic dissection and intramural hematoma. IRAD was established in 1996 and is comprised of referral centers in 13 countries. 

The IRAD database is available to participating healthcare providers. “Access to such a large data set helps us examine the issues we encounter,” Dr. Yoon says. “IRAD’s large, multi-center database allows researchers to identify trends, understand the presentation and management of aortic dissection, and guide best practices for diagnosis and treatment.”

For more information, contact Dr. Yoon at William.Yoon@UHhospitals.org.

Contributing Expert:
William J. Yoon, MD, PhD
Co-Director, Aortic Center
University Hospitals Harrington Heart & Vascular Institute
Clinical Associate Professor
Case Western Reserve University School of Medicine

Cristian Baeza, MD
Co-Director, Aortic Center
University Hospitals Harrington Heart & Vascular Institute
Clinical Associate Professor
Case Western Reserve University School of Medicine