The Aorta

The aorta is the largest artery in the body. It is shaped like a candy cane. It extends from the heart into the chest and down to the belly and legs.

After blood gets oxygen from the lungs, it moves through the heart and exits through the aortic valve. Then it enters the aorta, which carries the blood away from the heart to the rest of the body.

The aorta includes many parts:

• Aortic valve
• Aortic root
• Ascending thoracic aorta (in the chest)
• Transverse aortic arch
• Descending aortic arch
• Thoraco-abdominal aorta
• Abdominal aorta (in the belly)

Multidisciplinary Care

For people with complex aortic disease, the Center for Aortic Care offers the most advanced, comprehensive treatment options. The center brings together a nationally recognized team of specially trained experts, including:

• Cardiac surgeons
• Vascular surgeons
• Cardiologists
• Cardiac imaging specialists
• Genetic specialists
• Nurse clinical coordinators

Our team works with each patient to develop an individualized treatment plan. We coordinate appointment schedules to help make clinic visits comprehensive and efficient. Our goal is to achieve superior results for patients and to improve their overall quality of life.

Comprehensive Services

Dedicated nurse clinical coordinators arrange patient evaluations and second opinions for all types of aortic disease. We offer virtual visits upon request.

Services include:

• Individualized medical and surgical treatment plans based on the aortic diagnosis and needs of the patient
• Patient-centered surveillance that ensures the team keeps a routine, watchful eye on the patient’s aortic disease
• Advanced imaging and diagnostic testing to closely monitor the aorta for changes that may require further evaluation of the patient’s treatment plan
• Advanced surgical treatments, including minimally invasive endovascular and transcatheter options
• Access to clinical trials using advanced treatment options for aortic disease
• Genetic evaluation and counseling for aortic disease.

Cardiac Behavioral Medicine

Emotional well-being is key for patients with heart disease because depression and stress can slow healing and increase the chances of a future cardiovascular event. Patients with a new or existing heart diagnosis often experience increased stress and changes in emotional functioning.

The Northwestern Medicine Cardiac Behavioral Medicine team consists of clinical psychologists who specialize in helping patients with heart and vascular issues adjust to their diagnosis and treatment options by encouraging behavioral changes, improving coping strategies and minimizing stress.

Cardiovascular Genetics

Inherited heart and vascular disorders are genetic. This means that they can be passed down through families. The Northwestern Medicine Cardiovascular Genetics Program team consists of cardiologists and genetic counselors with expertise in inherited heart and vascular disorders. The program offers genetic testing to help diagnose these disorders and to provide treatment options for patients and family members.

Code Aorta

The Center for Aortic Care also offers "Code Aorta." This rapid patient transfer program helps ensure patients have faster access to expert care for aortic emergencies. These emergencies include ruptured aortic aneurysms and aortic dissections, which may require lifesaving surgery.

With Code Aorta, physicians outside of Northwestern Memorial Hospital who are treating a patient with an aortic emergency are connected with a Northwestern Medicine aortic surgeon. The surgeon determines if the patient needs to be transferred to Northwestern Memorial Hospital for treatment.

As part of Code Aorta, Northwestern Memorial Hospital has performed the highest volume of aortic aneurysm and aortic dissection surgeries in Illinois for five consecutive years.*
*COMPdata, Illinois Health and Hospital Association, 2018 – 2022

Aortic Disease Outcomes

The Center for Aortic Care understands the importance of tracking the volume of procedures we perform and the outcomes of the care we provide. Tracking allows us to evaluate the results of treatment options and to continue to improve the quality of care provided.

• In 2023-24, U.S. News & World Report named Northwestern Memorial Hospital cardiology, heart and vascular surgery program a top ten program in the nation (No. 7) and the highest ranked program in Illinois for 16 consecutive years.
• In 2023-24, U.S. News & World Report named Northwestern Memorial Hospital as “high performing” (the highest rating possible) for aortic valve surgery, transcatheter aortic valve replacement and abdominal aortic aneurysm.
• Northwestern Memorial Hospital has performed the highest volume of aortic aneurysm and aortic dissection surgeries in Illinois for five consecutive years.
  COMPdata, Illinois Health and Hospital Association, 2018 – 2022
• Northwestern Memorial Hospital has performed the highest volume of surgical and transcatheter heart valve procedures in Illinois for five consecutive years.
  COMPdata, Illinois Health and Hospital Association, 2018 – 2022
• Northwestern Memorial Hospital has performed more Ross procedures than any other hospital in Illinois, and has a 100% in-hospital survival rate.
  COMPdata, Illinois Health and Hospital Association, January 2021 – March 2023
  Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database, January 2021 – March 2023

Aortic Disease Clinical Trials

Physician-scientists in the Center for Aortic Care conduct clinical trials that provide access to innovative treatments for aortic disease. Clinical trials are investigational (experimental), which means they are not approved for commercial use by the U.S. Food and Drug Administration.

A clinical trial provides an opportunity to evaluate the effectiveness and safety of medications, treatments or devices. Patients who participate in clinical trials not only advance medical research, but may also have access to treatments not widely available. The following clinical trials are open for enrollment at Northwestern Medicine.

TAMBE: This prospective, non-randomized, multicenter clinical trial is being conducted to assess safety and effectiveness of the GORE® EXCLUDER® Thoracoabdominal Branch Endoprosthesis (TAMBE) device in patients who have an aortic aneurysm involving the visceral branch blood vessels requiring treatment.
Principal Investigator: Andrew W. Hoel, MD

Persevere AMDS: This prospective, non-randomized, multicenter trial is being conducted to assess safety and effectiveness of AMDS. This device is intended for aortic repair, aortic remodeling, and re-expansion of the intimal flap within the ascending aorta and aortic arch, and into the descending aorta for patients with acute DeBakey type I aortic dissection undergoing open surgical repair.
Principal Investigator: S. Christopher Malaisrie, MD

ARISE II: The purpose of this non-randomized, multi-center study is to assess the safety and effectiveness of the GORE® Ascending Stent Graft investigational device for treatment of lesions involving the ascending aorta and aortic arch including pseudoaneurysm, aneurysm, penetrating aortic ulcer and dissections (residual Type A, chronic de novo Type A) in patients considered to be high-risk for open surgical repair. Participants will be seen for follow-up visits at discharge, 30 days, 6, 12, 24, 36, 48 and 60 months post-treatment.
Principal Investigator: Christopher K. Mehta, MD

Thoraflex Hybrid and Relay Extension Post-Approval Study (EXTEND): The goal of this post-market, observational study is to evaluate the Thoraflex Hybrid device alone and in combination with the RelayPro NBS stent-graft for the treatment of aortic disease affecting the aortic arch and descending aorta with or without involvement of the ascending aorta. Participant involvement in the study will last for a total of 10 years from the point at which the Thoraflex Hybrid device is placed.
Principal Investigator: S. Christopher Malaisrie, MD

Zenith® Fenestrated+ Clinical Study: The purpose of this study is to assess the safety and effectiveness of the Zenith® Fenestrated+ Endovascular Graft (ZFEN+) in combination with the BeGraft Balloon-Expandable Stent Graft System and Unibody2 for the treatment of patients with aortic aneurysms involving one or more of the major visceral arteries. The ZFEN+ endovascular graft in combination with BeGraft covered stents and the Unibody2 are not yet approved by the FDA for marketing in the United States. Participants will be seen for follow-up visits 30 days, 6, 12, 24, 36, 48 and 60 months post-treatment.
Principal Investigator: Andrew Hoel, MD

IMPROVE-AD: The purpose of this multicenter, pragmatic, randomized trial is to determine clinical outcomes in patients with subacute (48 hours to 6 weeks) uncomplicated Type B aortic dissection (uTBAD). Participants will be randomized (1:1) to one of two strategies: thoracic endovascular aortic repair (TEVAR) + medical therapy compared to a strategy of medical therapy with standard of care surveillance for deterioration. Follow-up for up to 72 months will be ascertained via a centralized call center and ascertainment of medical records, as well as remote blood pressure monitoring.
Principal Investigator: Mark Eskandari, MD

Aortic Disease Publications

Participating in clinical trials related to aortic disease and publishing those results allows the Center for Aortic Care to shape the future of medicine. Our work with aortic disease is improving healthcare decisions and outcomes for patients at Northwestern Medicine and beyond.

View an extensive list of Northwestern Medicine publications on aortic disease. 

1. Mehta CK, Chiu S, Hoel AW, Vassallo P, Whippo B, Andrei AC, Schmidt MJ, Pham DT, Johnston DR, Churyla A, Malaisrie SC. Implementation of a direct-to-operating room aortic emergency transfer program: Expedited management of type A aortic dissection. Am J Emerg Med. 2023;70:113-118. doi: 10.1016/j.ajem.2023.05.036.  
2. Nightingale M, Scott MB, Sigaeva T, Guzzardi D, Garcia J, Malaisrie SC, McCarthy P, Markl M, Fedak PWM, Di Martino ES, Barker AJ. Magnetic resonance imaging-based hemodynamic wall shear stress alters aortic wall tissue biomechanics in bicuspid aortic valve patients [published online ahead of print, 2023 Jan 13]. J Thorac Cardiovasc Surg. 2023;S0022-5223(23)00019-3. doi: 10.1016/j.jtcvs.2022.12.021. (available on 2024 July 13).
3. Crawford EE, McCarthy PM, Malaisrie SC, Mehta CK, Puthumana JJ, Robinson JD, Markl M, Bonow RO, Fedak PWM. The need for comprehensive multidisciplinary programs, complex interventions, and precision medicine for bicuspid aortic valve disease. Ann Cardiothorac Surg. 2022;11(4):369-379. doi: 10.21037/acs-2021-bav-207.  
4. Malaisrie SC, Kislitsina ON, Wilsbacher L, Mendelson M, Puthumana JJ, Vassallo P, Kruse J, Andrei AC, McCarthy PM. Valve-sparing versus valve-replacing aortic root replacement in patients with aortic root aneurysm. J Card Surg. 2022;37(7):1947-1956. doi: 10.1111/jocs.16473.  
5. Soulat G, Scott MB, Allen BD, Avery R, Bonow RO, Malaisrie SC, McCarthy P, Fedak PWM, Barker AJ, Markl M. Association of regional wall shear stress and progressive ascending aorta dilation in bicuspid aortic valve. JACC Cardiovasc Imaging. 2022;15(1):33-42. doi: 10.1016/j.jcmg.2021.06.020.  
6. Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM 3rd, Chen EP, Fischbein MP, Gleason TG, Okita Y, Ouzounian M, Patel HJ, Roselli EE, Shrestha ML, Svensson LG, Moon MR; AATS Clinical Practice Standards Committee: Adult Cardiac Surgery. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2021;162(3):735-758.e2. doi: 10.1016/j.jtcvs.2021.04.053.
7. Bonow RO, O'Gara PT. Reconsidering the Ross procedure. JAMA Cardiol. 2021;6(5):548. doi: 10.1001/jamacardio.2021.0087.  
8. Mehta CK, Malaisrie SC, Budd AN, Okita Y, Matsuda H, Fleischman F, Ueda Y, Bavaria JE, Moon MR. Triage and management of aortic emergencies during the coronavirus disease 2019 (COVID-19) pandemic: A consensus document supported by the American Association for Thoracic Surgery (AATS) and Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS). J Thorac Cardiovasc Surg. 2020;161(1):48–53. doi: 10.1016/j.jtcvs.2020.06.004.  
9. Zamor KC, Eskandari MK, Rodriguez HE, Ho KJ, Morasch MD, Hoel AW. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg. 2015;221(1):93-100. doi: 10.1016/j.jamcollsurg.2015.02.028.  

*Bolding of author’s name indicates Northwestern Medicine staff and/or Northwestern University Feinberg School of Medicine faculty.