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Specialist clinics Healthcare Innovations 37


Diagnosis, management and interventional treatment of aortic diseases


Professor Christoph A Nienaber is a consultant interventional cardiologist, specialising in the field of endovascular interventions at the Royal Brompton and Harefield hospitals


P Eppendorf


rofessor Christoph A Nienaber graduated from the University Medical Centre Hamburg- and


travelled to the


University of California School of Medicine for a short while. Once he returned to Germany, he chaired internal medicine and cardiology at Rostock University Hospital and left to join Royal Brompton and Harefield hospitals in May 2015. In 1992, at the University Medical


Centre Hamburg-Eppendorf, he established the first integrated Marfan clinic, and he plays an impor- tant integral part in the Aortic Centre at the Brompton & Harefield Hospitals, now part of


the greater


Guy’s and St Tomas’ NHS foundation trust in London.


Clinical expertise Professor Christoph A Nienaber is a specialist for aortic dissection, aneu- rysm and stenotic lesions of aorta, coronaries and peripheral vessels, aortic valve stenosis, adult coarcta- tion,


hereditary connective tissue


diseases such as Marfan syndrome, Loeys-Dietz syndrome and Ehlers- Danlos syndromes. Tis wealth of experience is shown


in his approach to interventional treatment of acute and chronic coro- nary artery disease (percutaneous coronary intervention — PCI) and on the diagnosis and interventional (keyhole) treatment of chronic and acute aortic diseases. In 1996, Professor Nienaber


co-founded the International Registry of Aortic Dissection (IRAD) with two other cardiologists in the US, which grew to a global network for acute aortic conditions, and this enabled the pioneering of new endovascular techniques to treat aortic dissection.


Research interests and publications: Professor Christoph A Nienaber’s research


in coronary, aortic Professor Christoph A Nienaber


class II-occlusion and non-surgical management of aortic coarctation and vascular malformations. He has published more than 650 articles in peer-reviewed journal worldwide and contributes to a host of textbooks.


Scientific reviewer: Professor Christoph A Nienaber is an expert reviewer for a selection of journals, which include Te Lancet, European Heart Journal (EHJ), British Medical


Journal (BMJ), Circulation


and New England Journal of Medicine (NEJM) as well as having published numerous book chapters and peer-re- viewed scientific papers.


and


structural heart disease focuses on a modern interventional approach in the areas of complex coronary lesions (PCI), patent foramen ovale, tran- scatheter aortic valve implantation (TAVI), thoracic endovascular aortic repair (TEVAR), left atrial appendage (LAA) occlusion, atrial septal defect


Teaching As a professor in interventional cardi- ology, Professor Nienaber is sought after for national and international lectures as well as engagement in high-profile medical legal cases in Germany and the US. His expertise in coronary artery disease has helped shape international guidelines on the management and treatment of these pathologies.


Major interests and achievements: 1. CN and his team have initiated and established the endovascular treatment of aortic dissection and


aneurysm (keyhole intervention instead of an open operation) which can be a life-threatening condition. Tey started in the late 1990 over- seas (in a team with surgeons but with the intent to avoid open chest surgery) and developed non-sur- gical so-called endovascular strategies for dissection and aneu- rysm of the aorta even in patients with hereditary diseases such as Marfan’s disease. Tis manage- ment avoids the problems with open chest surgery, is performed on the beating heart and a very gentle way to deal with a major life-threatening problem. Patients usually go home after four or five days in hospital and have no scars on their chest or abdomen. Tis modern management has trans- formed the care for patients with aortic dissection from a purely surgical approach to a combination of medical management and stent placement inside the aorta to stabi- lise and reconstruct the diseased part of the aorta. Similarly, the envi- ronment where these interventions are performed has morphed from a classic surgical theatre to a modern high-tech imaging suite with the option to perform catheter-based keyhole procedures to patients with acute or chronic aortic conditions.


Morphological and 4D function MRI


While an open operation is avoided, these still need a dedicated team of specialists in interventions, in imaging and surveillance, during the procedure (which takes between one and three hours).


2. CN and his team conducts research on the evolution of aortic dissec- tion and early detection of patients at risk by use of modern imaging technology (functional CT and MRI) with the generation of stress maps of the aorta before it actually dissects. With new imaging tech- nology and image interpretation the stress on the inner wall of the aorta can already be measured and identified which hopefully will enable physicians in the near future to identify patients at risk for an event. Tis work is done in close cooperation with Imperial College and the Image Processing Team there.


3. Te modern care of patients with aortic diseases also affords the Establishment of a surveillance clinic with focus on managing patients with aortic conditions (before they become candidates for open surgery or a keyhole interventions). Patients are seen and worked-up by ‘aortic special- ists’ rather than by normal cardi- ologists or surgeons and form a partnership for life. Every patient will be followed by this ‘specialist team’ even after a successful inter- vention or operation to check for silent or late complications and to adjust the necessary medication during long-term follow-up. Some patients can be seen in a specialist nurse-led clinic once a baseline assessment has been performed by the aortic specialist. Tis model of care is revolutionary and will hope- fully be multiplied in the country and improve outcomes long term. Patients are highly compliant with their annual visits and highly satis- fied with this kind of dedicated care and ownership of their aortic specialist. Ongoing research will eventually provide the evidence for superiority of this model of care provided by an aortic centre with dedicated specialists compared to standard care.


Professor Nienaber has published more than 650 articles


4. Te team also sees an obligation in teaching and helping other less specialised colleagues with an interest in aortic diseases and will always


accept external patients


to provide a second opinion with regards to management and/or suggested surgery in any patient with aortic disease. Te service in the Aortic Centre also provides counselling for patients and their families if affected by a hereditary condition; for this purpose, clinical geneticists and counsellors are part of the ‘aortic team’ to explore poten- tial genetic underpinnings in a given case, and to consult about future occurrence of similar conditions in the children of a given patient should there be a familiar condition.


In summary, with a particular interest in aortic diseases, with the experience of 10,000 patients collected in the international registry of aortic dissec- tion (IRAD) and with the invention of new keyhole catheter based proce- dures, Professor Nienaber has seen a complete transformation of care for patients over the past 20 years: from open surgery or watch-and-wait only to a dedicated individualised approach often involving non-surgical atraumatic keyhole procedures and a tailored surveillance programme. Te model of care for these patients has definitively changed in those ‘aortic centres’ for the benefit of the patients.


Professor Christoph A Nienaber MD, PhD, FESC, FAHA Imperial College Te Royal Brompton & Harefield NHS Trust Consultant / Cardiology and Aortic Centre Sydney Street, London SW3 6NP c.nienaber@rbht.nhs.uk


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