MUSC Health first in South Carolina to implant novel device for patients with complex aortic disease

March 27, 2023
A woman and man smile in a hospital bed. The man is the patient. She is visiting him.
Larry Flowers with his wife during his recovery from surgery. Photos by Lauren Hooker

Following the recent U.S. Food and Drug Administration approval of the GoreTAG thoracic branch endoprosthesis (TBE) device for treating patients with complex aortic arch disease, MUSC Health announced it was the first medical center in the state of South Carolina to implant the commercially available device, with two teams performing the procedure on patients on March 3. TheTBE device provides a solution for patients with complex tears in difficult-to-reach anatomy – one that does not require an open surgical procedure.

The novel device consists of two components that line the thoracic aorta and the left subclavian artery. It allows blood to flow into the left subclavian artery and the rest of the aorta while preventing blood from flowing to the affected area. 

During a thoracic branched endograft procedure, MUSC Health vascular surgeons and cardiac surgeons work together on the case. This type of multidisciplinary team approach is the key to success in complex aortic surgeries. First, the surgeons insert the stent graft through the artery in the groin and guide it up into the aortic arch in the chest, using X-ray technology. The stent graft is used to repair problems with the aorta in the chest while still maintaining important blood flow to the brain and arms. 

People wearing hospital scrubs work in an operating room. 
On March 3, the aortic surgery team was the first team in South Carolina to implant the minimally-invasive novel device for patients with complex aortic disease.

The branched TBE device is the first and only FDA-approved implantable thoracic branched endoprosthesis offering a fully endovascular, or catheter-based, treatment option for patients with aortic diseases, in close proximity to the important aortic arch branches.

“With the TBE device that is now commercially available, we are able to extend the repair beyond the subclavian artery closer to the heart without sacrificing the subclavian artery,” said vascular surgeon Mathew Wooster, M.D. He said this was the case for the first patient in South Carolina who received the implant.  

Mathew Wooster, MD 
Dr. Mathew Wooster

“Larry Flowers had an aortic tear in a section of his aortic artery that, until now, has been very difficult to treat,” said Wooster, explaining that before this device became commercially available, the options were limited for patients like Flowers. “In the past, surgeons would have to complete a subclavian bypass or create a physician-modified graft, but now this new device allows us to provide more optimal care while avoiding incisions,” he said. “And Mr. Flowers' anatomy made him a perfect candidate for this procedure.” 

Flowers first noticed symptoms when he and a friend loaded a piece of heavy equipment onto his trailer near his home in Camden, South Carolina. “We had difficulty loading a heavy lawn mower onto the trailer, and when I tried to pick it up and push it onto the trailer, I immediately felt a terrible pain near my heart,” he said. “At first, I thought I had a heart attack.” 

He called his wife and son, who got him to the emergency room at the local hospital. “But first, we went to our church and asked the pastor for prayer,” said Flowers.  

Once he arrived at the hospital and was assessed, it was found that he had a tear in his aorta. The medical team then airlifted him to MUSC Health-Columbia Division. He was stabilized and then transferred to the cardiovascular intensive care unit at MUSC Health in Charleston, due to the complexity of his case. Cardiothoracic surgeon Nicolas Pope, M.D., evaluated Flowers and consulted with Wooster to see if Flowers would be a candidate for this novel device. 

A patient in a hospital bed wearing glasses smiles while posing with a patient care tech who has long black wavy hair and is wearing a white t-shirt. 
Annetta Hebrebrand-Verner, pictured with patient care technician Candace Campbell, thanked everyone who took such good care of her during her operation and recovery.

They determined that he was a perfect candidate, and the next day, the two surgeons performed the first minimally invasive TBE implant in the state. “At the MUSC Health, our aortic surgery team of highly specialized vascular and cardiothoracic surgeons works together on these complex cases to create optimal patient outcomes,” explained Wooster. “Mr. Flowers had an excellent outcome, and we were happy to be a part of his medical journey.”  

“I thank the Lord for guiding me to the expert care at MUSC Health,” said Flowers, a father of seven. 

That same day, the second endovascular TBE implant was performed on Annette Hebebrand-Verner, this time with a team comprised of Ravi Veeraswamy, M.D., chief of Vascular Surgery, and cardiothoracic surgeon Sanford Zeigler, M.D., with assistance from Wooster. 

Sanford Zeigler MD 
Dr. Sanford Zeigler

“Ms. Hebebrand-Verner was also a perfect candidate for this procedure, based on the location of her aortic disease, found during medical testing based on her family history,” said Zeigler. “This new device allowed us to treat her disease without having to make a separate incision to bypass the aorta or alter grafts that were not built to cross branches.”  

Hebebrand-Verner has a family history of aortic disease. “My father died of an aneurysm in 1981. He was the same age I am now,” she explained. “When experiencing some heart-rhythm issues, I asked my primary care provider if it would be prudent to also check for any aortic disease, based on family history. He agreed, and sure enough, the CT scan showed a small tear in the same area my father had his disease.”

She was then referred to the aortic surgery team at MUSC Health, and within a few days, she had a consult with Zeigler. Hebebrand-Verner said she immediately knew that she was in good hands. “My brother is a surgeon in Germany,” she said. “His cardiothoracic group was highly complimentary of Dr. Zeigler’s expertise.”  

“Not only is he an excellent surgeon, but he also has an excellent bedside manner, always taking time to answer my questions – before and after my procedure,” she said. “God led me to follow up with my primary care provider, which led me to these great surgeons.” 

Get the Latest MUSC News

Get more stories about what's happening at MUSC, delivered straight to your inbox.