On the occasion of his speech at the “Athens Crossroad” Cardiothoracic Surgery Congress, CNN Greece spoke with the cardiac surgeon Konstantinos Spiliotopoulos about the advances and innovations in his sector. The specialist doctor, who is active in all range of cardiac surgery, spoke to us about the “silent epidemic”, namely the thoracic aortic aneurysm, which can constitute a serious hazard to our health. For this reason, information to the general public on this crucially important issue is necessary, so that there is early detection and treatment. What should we know about this matter and how important is prevention for the health of our heart?
You participated recently in the “Athens Crossroad” Congress which took place in connection with the organization of the 12th Congress of the Hellenic Society of Thoracic & Cardiovascular Surgeons. What innovations were discussed? What issue did your speech concern?
This year’s Cardiothoracic Surgery Congress in Athens was quite successful due to the high participation of top specialists from around the world and, of course, from Greece. All the latest innovations in our specialty were discussed, such as the minimally invasive treatment of heart and thoracic diseases with small incisions, robotic cardiothoracic surgery, the transdermal treatment of structural diseases of the heart and heart valves, as well as the transcatheter-endovascular treatment of aortic diseases, such as aneurysms and dissections.
My speech regarded the most specialized experience we have acquired in the last years, both in Greece and abroad, in the surgical treatment of not so frequent, but difficult complications of the constantly increasing endovascular aortic operations. The message of my speech regarded the strict application of the correct indications for performing these innovative, minimally invasive methods, that are performed by properly trained and experienced medical teams, as well as the emphasis that must be given to the regular post-operative monitoring of the patients, so that possible complications are diagnosed early and treated in high specialization centers.
You are active in all range of cardiac surgery and, in particular, you are specialized in Aortic Surgery. Why did you choose this sector?
Aortic Surgery as a specialization of cardiac surgery presents particularities in the planning, methods, techniques and the general organization of surgical operations. The surgical specialist must deal with a range of pathological conditions that constitute a direct threat to the patients’ lives, such as aneurysms and aortic dissections, that require early diagnosis, as well as making the proper therapeutic decisions for the best possible result in relation to each patient (individualized management). My clinical training in Toronto, Canada and Houston, USA, under the supervision of two of the top aortic surgeons in the world, the professors Tirone E. David and Joseph S. Coselli, respectively, offered me the opportunity to deepen my knowledge regarding the principles of cardiac surgery and its applications in the clinical practice, at the highest possible levels, for each patient separately.
Recently, we had also the great pleasure to welcome and attend the speech of professor J. S. Coselli, who was an official guest speaker at the Panhellenic Congress of Cardiology, where he analyzed his personal experience in the surgical treatment of more than 3,500 cases of thoracoabdominal aortic aneurysms, which renders the Cardiothoracic Surgery Clinic of the Baylor College of Medicine & Texas Heart Institute, of which he is the head, a reference center globally for these surgical operations.
You have been trained and worked in the most recognized medical universities and hospitals in the USA, Canada and England. Do you consider that the services in the Health sector that are provided in these countries are better than the ones of Greece? And if yes, how could Greece improve?
In all Health Systems there are both positive and negative aspects, as well as treatment teams and centers that are distinguished. It is important that there are established, reliable and functional national systems of internal and external assessment of the provided services, so that the measures that are required are taken each time and a satisfactory average level of safe, scientifically adequate and decent for patients health care is ensured. Regarding this point exactly, I consider that there is large room for improvement for our country.
What should the general public know about thoracic aortic aneurysm?
The aorta is the largest artery in the human body and carries oxygenated blood from the heart to the other organs and tissues of the body, which renders it necessary for its survival. Aortic aneurysm is the abnormal dilatation (similar to a bubble) of its wall, when it weakens and loses its normal structure and resistance to the pressure of blood that passes through it, for various reasons. The aneurysms of the thoracic aorta are called “thoracic aortic aneurysms” and can be detected in any of its individual parts, such as the aortic root (its heart origin), the ascending aorta, the aortic arch and the descending thoracic aorta. More extended aneurysms can involve both the thoracic and the abdominal aorta and are called “thoracoabdominal aortic aneurysms”.
It has been estimated that in the USA, 15,000 patients are affected every year by thoracic aortic aneurysms, while approximately 47,000 patients die every year from every type of aortic disease, more than the ones who die from breast cancer, AIDS or road accidents, rendering it a “silent epidemic”.
Thoracic aortic aneurysm is a serious hazard to the human health because, depending on its localization and size, it can rupture or dissect (tearing of the layers of the aortic wall), causing a life-threatening internal bleeding, which requires urgent surgical treatment.
However, if it is detected early, a thoracic aortic aneurysm can usually be treated with surgery or with other less invasive methods on a regular basis with better results.
Often thoracic aortic aneurysms go unnoticed. How can their timely diagnosis be made?
Often thoracic aortic aneurysms go unnoticed, due to the lack of symptoms in half of the patients that are affected by them. In the other half, they may cause chest pain, pain in the mandible, neck and back, persistent cough, horse voice or dyspnea. The early diagnosis of thoracic aortic aneurysms is important for their effective treatment, in the light of the risk of their rupture with possibly fatal consequences for the patients. The hazard of rupture is increased proportionally to the speed of increase of the size of aneurysms. For this purpose, the following imaging tests can detect and establish the diagnosis of thoracic aortic aneurysms, contributing to their early treatment:
-Chest X-ray
-CT scan - angiography
-MRI scan
-Echocardiogram
-Angiography
The endovascular treatment of diseases of the thoracic and abdominal aorta has developed rapidly in the last years. What is the greatest innovation according to you?
As an alternative to the classic open surgical treatment method and depending on the anatomical localization in the descending thoracic aorta, it is possible to propose the new endovascular method of repair of thoracic aortic aneurysm (TEVAR), with which the open access is avoided and the exclusion of the aneurysm is achieved through catheters and endovascular grafts with minimally invasive techniques. These innovative methods have also expanded to other anatomical locations, such as the thoracoabdominal aneurysms and the aortic arch aneurysms, with the development of the proper endovascular devices with a personalized manufacture procedure for each patient, which consists a very important development. The application of these innovative methods is already a reality in the last two decades in modern centers abroad (USA, Europe), while in the last years they can be applied in respective high specialization centers in Greece by appropriately trained surgeons and teams. However, the optimal treatment approach for thoracic aortic aneurysm depends on the judgment and the responsible consultation of the specialized medical staff.
How important is prevention for the health of our heart? What must we be careful of?
Prevention consists the most important care for the health of our heart. We must all take care so that we avoid or treat the cardiovascular risk factors, such as arterial hypertension, diabetes mellitus, smoking, dyslipidemia, obesity and sedentary life-style, stress and poor socialization.
Finally, we must follow the instructions that regard the appropriate preventive tests, depending on our age and gender. As in all other cases, we must be careful in order to be safe!
