Featured faculty
Derek R.brinster, MD
Thoracic Aortic Surgery
The discovery of aortic disease comes as a total surprise to many patients, as generally there are few, if any, warning symptoms. In fact, the vast majority of non-emergency aortic diseases are revealed through incidental imaging such as an echocardiogram, chest x-ray, CT scan or cancer workup.
“Although no patient likes to have a diagnostic procedure for one thing only to discover that he or she has another such as aortic disease, it certainly is better than the alternative of finding out through a life-threatening emergency such as an aortic aneurysm rupture or dissection,” said Derek Brinster, MD, director of Pauley Heart Center’s Thoracic Aortic Surgery Program.
An aortic rupture occurs when an aneurysm, or abnormal bulge in the wall of the aorta breaks, causing life-threatening internal bleeding. An aortic dissection is a longitudinal tear of the inner layer of the aortic wall, allowing blood to leak into the wall itself and cause separation of the inner and outer layers.
“About 80 percent of the Thoracic Aortic Surgery Program’s patients are non-emergencies, that is they have suspected or confirmed aortic disease of some type. The remaining 20 percent are emergency surgeries, the majority of whom come through our emergency department or from referring cardiologists and hospitals that have established referring patterns or have heard about our program.”
“Our program is set up not only to treat aortic disease surgically, but as a medical disease management program so that we can provide excellent care across the disease repertoire. That includes the full array of diagnostic services, as well as a personalized care strategy that may include medical therapy, lifestyle modifications, ongoing monitoring and elective surgical treatments, to the other end of the spectrum, accepting the sickest of the patients who have had an aortic catastrophe,”
said Dr. Brinster. “We have a large population of patients that we follow closely, often working in conjunction with their primary care physician to ensure that they are as safe as possible.” The program has grown significantly since 2003 when
Dr. Brinster was recruited to the Division of Cardiothoracic Surgery to develop and build a program specific to serious aortic conditions. Aortic surgery work alone has undergone a five-fold increase. He credits the program’s success to the fact that Central Virginia had a considerable need for a center dedicated to the aortic disease process, and to the multi-disciplinary team and sophisticated facilities VCU Medical Center provides.
“As a tertiary/quaternary care center, we have great expertise around the clock, not just in terms of surgeons and cardiologists, but also intensivists, radiologists, cardiac anesthetists, critical care staff and nursing support, as well as a dedicated cardiac surgery intensive care unit,” he said. “We have gained a regional and national presence as referring physicians have become more and more familiar with our program and our desire to have complex patients brought here. We never say no and we have a fast patient transfer process.”
Dr. Brinster sees continuing expansion of the program’s work on ascending aorta and aortic reconstruction, aortic arch, descending thoracic aorta, and thoracoabdominal comprising the thorax and abdominal. In addition, he thinks that minimally invasive endovascular approaches will continue to be developed, refined and expanded for use in even some of the more complex surgical repairs.
“Some aortic programs box themselves into doing either open or minimally invasive techniques. We think that it is very important that our program is expert at both so that we can select what is best for the individual patient, never sacrificing patient care because of limitations on what we can do. Our goal always is to give each patient the best treatment for his or her unique needs.”
