well thanks for the organization for inviting me. And especially for my colleague today is going to be more of a presentation of who we are. Um how do we do it? What do we do and try to a little bit project us into the future. So um this is basically a multidisciplinary team and that's what it makes. I would say the whole story. I moved into the U. H. family around the same time with Jay Chou three years ago we were trying to work hard on put these teams together. So this is the you know the four phases were way more but myself and and I was administrator Becky and and Megan um that we also want to try to mention who we were with and basically this is all about multi specialty. Um um So we have the vascular medicine with Heather Gornick here um leading us uh we have the a very now actually getting bigger quite a surgery team. We have the vascular friends as well. Before that it's not here but I want to mention the work with you with with Anna Mitchell, you know genetics. She's from pediatrics and had a picture here, but now it's gone anyway. But we work with her in an effort to do this as comprehensive as we can. Uh Now what we have done in this last year and a half that we're working together, we already put in place. This is I don't want to get into I just want to show you that we have the A. C. T. Or the care team that which is very basic. It's we are always open 24 73 65 to receive to receive any kind of patient with acute barre syndrome that might need our help. Uh And this is a very you know simplified protocol basically that you know anybody who in a patient with this kind of problem can call us and we say yes that's the first thing we say. We say yes and then we'll take it from there. I'm going to have a conference call in the middle of the night or whenever it needs to be done to make the best decision now. How do we interact being so many teams And we've been working on this and this is an evolving way of of relationship but but but basically we have a very nice meeting. We do every Wednesday with all the fellows and all whoever wants a patient we need to discuss hopefully before the procedure so we can all have an opinion about that and suggest. And most of the time I would say actually we are we're we're looking at these numbers but we get a change in our strategy who is going to be used for that patient based on discussion conversation among all these specialties. Um Sorry we also have our Journal Club which is internal but also we have a wider meeting that we do with our friends from the Cuban clinic. We have the first one it was a great experience so we had a chance to talk and discuss and discuss cases. Um And in terms of what we what do we do? Well we have a bunch of diseases that we want to focus on. The first of all. Aneurysm from all. You know the aura which is for us we consider is the aortic wall playing all the way down to the bifurcation. Um So aneurysm from the sending arch or initial descending, you know abdominal abdominal. And how do we treat it? Well there's many ways and that's another thing that having such a variety of specialty together. We can actually offer a wide range of different treatments. We can be open right like you see there uh and this is an abdominal picture and you can see complete, you know, endovascular treatment, minimally invasive. All Perky titanius, you know that actually no uh gives the patient the opportunity to not just recover very easy and very fast but also we can engage on treating you know higher risk patients. Um We more and more. We're evolving on, you know advanced um devices you know with ministrations were looking forward forward on what's coming on new devices for treating the arch and the ascending aorta. And we will be very very involved in all these new trials of course. Treatment of this. You know, you can see very complicated treatment here. This is an abdominal with administration and both and both reno's arteries being scented. This is something that it's actually um it's a way of treating this is this is very complicated. Um And that's the final result. You can see we have very good results on totally per container. This technique. Now we also get engaged very intimate related with the A. C. T. Activation which is dissection, hematomas or penetrating ulcers. I'm not going to get into a dissection but you know it's always a challenging it in terms of time anatomy and how do we treat it? We have you know the hematoma penetrating ulcers. This is an example of a complicated type B dissection. Uh And basically especially uh with the journalism generation. We can we can combine treatment with what we call it hybrid with open technique with also endovascular technique. So and you can have this way of approach for you know the the idea is is customized the procedure for every different patients and situation. Um And finally also for high surgical risk. We can always entertain the idea of a total per cutaneous repair. And this is a complicated dissection of the arch. And this is a very high tech advanced way of treatment where you have here different procedures. You can see you know surgical revascularization. You can see this is a chimney type of combination of of arch stands a sending arch stand. And also you have a plug to include the the the takeoff of the left subclavian to avoid uh and Alex. So the chances opportunities of treating this is tremendous. Um So um and finally of course occlusion disease. Like we we have this, you know, inclusion or um um coral reef, the aura, the opportunity for this. There's of course a variety as well. Very high complicated open repairs. And I'm going to stop here to give the opportunity to dr jay chou to talk about the future future. I want to thank the opportunity of the University hospital and and Harrington Heart and vascular institute for for having us given the opportunity to put this together. What I think is it's finally as a doctor mary said, put the patient at the center of the universe. Thank you very much. Thank you chris. Um But not everybody can have operations. This extend, extend this extensive that requires opening both Jurassic and abdominal cavities. And with increasing interest in noninvasive or minimally invasive operations. That is a tremendous need for us to um provide minimal invasive therapy for both dark abdominal arch as well as a sending yura. And here is an example of a endovascular solution for abdominal aortic aneurysm. Now there are several devices more in europe than the United States, But none of these are commercially available in the United States for example. Gold can be devised. The first pivotal trial patient was done in 2019 and cooked T branch device was obtained the percy mark in 2012 almost 9.5 years ago in europe. But it is still being evaluated in the United States but these patients cannot wait 9 10 years. Right? So we have to continue to come up with solutions to provide care for this uh sick patients. Thank you you know a good thing. So with dr corporate arrival and joining us about 2 2.5 years ago we started our Pimek program to provide minimal invasive solution to these patients. And you can see our back table and modification of our devices. Uh Dr Colbert is in the middle screen with our former fellow. And the final product is you can see on the right side of the screen and that device was placed into participation. As you can see this is you can see the rings three rings in the middle of the graft. Those are the locators for the administration's openings to get into the visceral vessels. and 1 1 of the best right here is selected S. M. A. And there's a stand crap going into the S. M. A. And it's a flow into the S. M. A. And you can see that all of his professors were successfully calculated um for the arch device for the archery lesions. It's also important um that we come up with the minimal invasive solution and one of the ways to obviously um move forward is to participate in clinical trials that evaluate investigative devices. And we just heard. And then we were selected as one of the sites for this triumph graft which is actually uh made in Israel. And this is a combination of a hybrid approach for the denominator graft as you show in the the on the slide here and that is deployed first and then followed by placement of a sending graph. So it's a two step step grafting. But this also requires crowded, too crowded and crowded subclavian bypass, gravity again. But these devices are not readily available and it takes time. And one of the ways we can also um uh treat these patients is to come up with a uh minimal invasive grafting for the arch and a sending and this is a a slide provided by dr William youn who's actually visiting us and in the audience that he performed about six months ago. That is a total. And the vascular solution for are genuine Ism um the only thing that was done surgically is control of the crowded arteries to prevent embolization and creditors of criminality bypass but is a cutting edge technology. Obviously the other way uh that we are also looking to move forward is in the areas of research. And one of the things that we're interested in is identifying patients who are at high risk of developing every pathology And uh Dr Rajagopalan has this uh study that he does a free screening for calcium scoring for patients with coronary artery. And from the data more than 36,000 patients that we have a screened. We have found that About 8.6% of these patients actually had thoracic aortic aneurysm that was detected on the screening. And the risk factors were usual, usual factors such as age, male hypertension and all. But it was interesting to see that 20% of men who actually will qualify for aortic aneurysm screening also noted characteristic of the aneurysm, which is a striking number. And I think these are one of the areas where we can concentrate on identifying patients who are at risk of developing every pathology, whether it is a pure aneurysm or dissection. Okay, we'll move around uh another area that we're interested in is identifying, defining the molecular pathology for high risk, high mortality patients in patients who undergo aortic aneurysms. And we saw we found that patients actually with elevated N. L. R. Has a very differential gene expression there was that related to a complement activation. So that would be one of the areas that we will be pursuing in the interest of time. I will stop here and uh I'll be happy to entertain any questions in discussion section. Thank you for your attention
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