Complex aortic repair at Penn Medicine | An interview with Grace Wang, MD

Grace J. Wang, MD, MSCE, is the Vascular Director of the Penn Aorta Center. Recently, we spoke to Dr. Wang about the Center and the history of aortic disease management at Penn Medicine.

Q: Dr. Wang, the Penn Aorta Center was formally established in 2024 to align the efforts of cardiac and vascular aortic surgeons, but its origins go back considerably further. Can you speak to the history of innovation in aorta care at Penn Medicine?

Grace Wang, MD: For decades, Penn has been a leader in the development and clinical evaluation of new treatments for aortic disease. From the 1990s onward, Penn physicians have led and participated in clinical trials, including numerous thoracic, abdominal, thoracic branched and thoracoabdominal aortic stent graft feasibility and pivotal trials. Penn has thus been at the forefront in bringing these devices to approval, enabling cutting edge therapy to be applied for our aortic patients.

Q: The Aorta Center highlights the multidisciplinary nature of care for aortic patients, but is also unique in its ability to treat high-risk patients. Can you elaborate on the patient population the Center was designed to serve?

Grace Wang, MD: Certainly. Today, the Aorta Center offers comprehensive treatment for patients with the most complex aortic conditions, including thoracoabdominal and aortic arch aneurysms, chronic aortic dissections, syndromic and nonsyndromic heritable aortopathies, and issues that develop after prior open or endovascular aortic repair.

For appropriately selected patients, minimally invasive endovascular repair can avoid the physiologic stress of major open aortic surgery and can markedly reduce perioperative morbidity, shorten hospitalization, and accelerate recovery.

Q: Dr. Wang, how does the Aorta Center individualize treatment in a population noted for its diverse and varied needs?

At Penn, treatment is tailored to the patient. Penn offers the full range of commercially available endovascular technologies, but also has access to custom-designed devices that are not available at other hospitals in the region. As part of Dr. Darren Schneider’s investigational device exemption trial, patient-specific endovascular stent grafts can be designed which can accommodate unique features of each patient’s aortic anatomy. Particularly in patients who have undergone prior aortic surgeries or stent procedures, their anatomy is complex, and there may be constraints that limit the use of commercially available devices. This allows our specialists to personalize treatment rather than trying to make every patient fit a single device or treatment strategy.

Q: Dr. Wang, you’ve mentioned patients with high-risk and complex conditions. Among the most complicated populations in aortic surgery are patients returning for a second or third procedure, and patients with heritable aortopathies. How are these patients managed at the Aorta Center?

Grace Wang, MD: We see many complex patients at the Penn Aorta center, and many have already undergone one or more previous aortic repairs.

Penn specialists have extensive experience treating patients with progressive aneurysmal degeneration, chronic dissection, endoleaks, device-related issues, and disease involving segments of the aorta that were not treated at the time of the original repair. Advanced endovascular and hybrid techniques can often provide additional options after prior open or endovascular surgery.

The Penn Aorta Center also provides comprehensive care for patients with connective-tissue disorders and inherited aortic conditions, in whom treatment decisions must consider not only the immediate problem but also the patient’s lifetime risk of progressive aortic disease. Through partnerships at CHOP we are able to shepherd these patients as they receive care for various stages of repair of their aorta. In addition, with our maternal fetal medicine colleagues, we are able to formulate plans for young women with heritable aortopathies who are contemplating pregnancy or who are already pregnant.

Q: Dr. Wang, how does the Aorta Center approach aortic treatment?

Grace Wang, MD: At Penn, aortic disease is approached with the concept of “one aorta.” Treatment of one segment of the aorta can impact future repair options as well as the success of subsequent procedures. For that reason, Penn vascular and cardiac surgeons work together to plan treatment of the entire aorta, understanding the downstream impact of interventions, and with the patient’s lifespan in mind.

Q: What does multidisciplinary care for aortic disease bring to surgical management at the Aorta Center?

Grace Wang, MD: Penn is one of the busiest aortic programs in the country, and the expertise required to deliver care for these patients extends far beyond the operating room. Complex aortic procedures depend on an experienced multidisciplinary team and the infrastructure to support every phase of care, including advanced imaging and procedural planning, specialized anesthesia and critical care, as well as experienced nursing. Having a multidisciplinary aortic team ensures the best outcomes for our patients. In addition to the multidisciplinary care that the patient receives at the time of their index operation, dedicated surveillance strategies with clinic follow-up and imaging follow-up is critical to ensure the continued success of the procedure.

That combination of procedural volume and multidisciplinary expertise is particularly important for patients with extensive aneurysms, dissections, genetic aortic disease, or previous aortic repairs. These patients may require a creative solution or approach to their clinical problem, which leverages the deep experience of our aortic team.

Q: You highlighted clinical trials as a part of the Aorta Center’s history. Is this a continuing effort? What’s happening today at the Center?

Grace Wang, MD: As I mentioned previously, a major distinction of Penn’s program is the FDA-authorized, investigator-sponsored investigational device exemption study led by Dr. Darren Schneider evaluating endovascular repair of thoracoabdominal and aortic arch aneurysms using off-the-shelf and patient-specific fenestrated and branched stent grafts (ClinicalTrials.gov NCT02323581).

Thus far, approximately 500 patients have been treated through this program, making it one of the largest experiences with these advanced technologies in the world. This is part of the ability to deliver personalized care at the Penn Aorta Center.

When commercially available devices are not suitable, a stent graft can be specifically designed and manufactured to match an individual patient’s anatomy.

This can make minimally invasive treatment possible for patients whose anatomy cannot be treated with standard commercially available devices, a capability that is particularly valuable for patients with extensive thoracoabdominal or aortic arch aneurysms, chronic dissections, complex anatomy, or previous aortic repairs.

Penn thus continues to lead clinical trials that provide access to new aortic technologies which are not commercially available.

Q: Dr. Wang, summing it up, how would you describe the Penn Aorta Center to referring physicians?

Grace Wang, MD: For patients with complex anatomy or difficult aortic disease, Penn offers a breadth of expertise and treatment options that are not available at other hospitals in the region.

Penn’s combination of high procedural volume, multidisciplinary expertise, extensive experience, personalized treatment, and access to advanced and investigational technologies makes the Aorta Center a destination for patients with the most challenging aortic conditions.

Referrals and consultations

Whether you’re in Greater Philadelphia or elsewhere in the country, the Aorta Center welcomes inquiries.

To make a referral to the Penn Aorta Center, please call 877-937-7366.

The team is equipped to handle complex aortic needs, including reinterventions after previous surgeries.

Other reasons to inquire about possible referral include:

• Aortic insufficiency
• Bicuspid aortic valve or related repair/replacement
• Diagnosed connective tissue disorder
• Dissected aorta
• Enlarged thoracic aorta (4 centimeters or more): Family history of thoracic aortic aneurysm or dissection or known, related mutation
• Repaired congenital heart defect