Cardiology Articles from Ochsner Health Experts

Endovascular Expert, Dean Yamaguchi, MD, Elevates the Ochsner Aortic Center

In May 2025, vascular surgeon Dean Yamaguchi, MD, director of the Ochsner Aortic Center at Ochsner Medical Center - New Orleans, joined the health system with a clear mission: to enhance the Ochsner Aortic Center’s ability to deliver leading-edge endovascular therapy. 

This assignment carries added urgency at a time when patients with vascular disease increasingly seek care later in their disease processes, delays largely driven by social determinants of health, according to Dr. Yamaguchi. He calls barriers to timely vascular disease care a “national challenge.” Under his leadership, the Ochsner Aortic Center is well-positioned to provide the latest treatment innovations to generations of patients. 

How a Clinical Interest Took Shape 

Dr. Yamaguchi credits his vascular surgery fellowship at the University of Alabama at Birmingham with sparking his interest in complex aortic disease. He calls the time he spent there under the tutelage of renowned vascular surgeon William D. Jordan Jr., MD, some of his “best years of clinical work.” 

"Dr. Jordan was at the forefront of the field, pushing the envelope, trying to do things from an endovascular perspective, but ensuring we, as trainees, also developed open surgical experience,” Dr. Yamaguchi said. “He provided us just enough autonomy to be confident as surgeons, but also the ability to fall back on him and his faculty to help us through tough cases.”

Shifting From Open to Endovascular Surgery 

The Ochsner Aortic Center exemplifies the shift in vascular surgery from open operations to endovascular procedures, which expedite recovery and reduce the risk of morbidity and mortality. 

Dr. Yamaguchi specializes in performing minimally invasive complex aortic repairs using stent grafts, particularly physician-modified endografts (PMEGs). Dr. Yamaguchi likens these specialized stents to custom cars because physicians can customize them based on a preoperative CT scan to fit the patient’s anatomy, increasing the durability and safety of the repair. 

“I can take off-the-shelf stent grafts used for standard aortic repairs and customize them with fenestrations, or holes, cut out for specific arterial branches, such as kidney or intestinal arteries, to preserve blood flow,” Dr. Yamaguchi said. “This allows us to fix aneurysms and aortic dissections with stent grafts without compromising blood flow to these important visceral arteries.” 

Dr. Yamaguchi can modify stent grafts both outside and inside the body. For example, he can place stents across the arteries and burn holes in them to maintain blood flow. This procedure, known as laser fenestration, can be performed from the aortic arch to the abdominal aorta. Performing endograft operations on a large scale at Ochsner prevents patients from Louisiana and Mississippi from having to seek care in Houston or Birmingham. 

Enhancing Care After Surgery 

Postoperative care, too, has advanced rapidly. 

“When we perform large aneurysm repairs that span the chest into the abdomen, there’s a risk of spinal cord ischemia,” Dr. Yamaguchi said. “We have protocols in place to help manage those patients postoperatively so we can reduce their risk of paralysis or weakness in the legs. In general, patients to whom we would never have offered these sorts of repairs because of their age or comorbidities now have the option of a less invasive way of fixing complex aortic problems.” 

Dr. Yamaguchi believes this underscores how his field has advanced since he was in training. Patients who, in the past, would only have been candidates for palliation can now receive definitive treatment. 

Combining Two Approaches 

Sometimes, ensuring each patient receives the optimal procedure requires blending open and endovascular approaches. For example, if a patient has an aneurysm in their aortic arch, Dr. Yamaguchi can perform a short bypass procedure between the carotid arteries and put in an off-the-shelf branch stent to repair the bulge. 

In another example of a hybrid open/endovascular approach, Dr. Yamaguchi treated a patient with Marfan syndrome and an aortic dissection with a two-stage operation. 

“The standard of care is an open, emergent surgery, which carries a higher risk of complications,” Dr. Yamaguchi said. “We ended up performing a repair in stages. We stabilized the patient in the acute phase with a stent graft in the chest. Then, we brought the patient back electively to repair the remainder of the dissection in his abdomen with open surgery. The patient recovered well and is doing great.” 

According to Dr. Yamaguchi, stent grafts in patients with Marfan syndrome typically have poor durability. However, by combining the stent graft with open surgery, the vascular surgery team increased the repair’s durability by fixing the bottom of the aorta with the more invasive operation. 

Track Record of High Quality & Patient Satisfaction 

Dr. Yamaguchi’s unwavering transparency in the shared decision-making process complements his clinical and technical expertise. His straightforward approach to patient interactions earned him consistently high satisfaction ratings and contributed to a perfect score of 100 in Medicare’s Merit-based Incentive Payment System. He credits transparency, honesty and doing his job to the best of his ability as the essential ingredients to his success. 

“I always have the difficult conversations with patients before surgery,” Dr. Yamaguchi said. “I explain the risks and benefits to them just as I would to my parents or sisters. Transparency is key.” 

Future of Collaboration & Technical Innovation 

As the Ochsner Aortic Center continues to enhance its capabilities, Dr. Yamaguchi sees cross-specialty collaboration as a key to its future. The center’s vascular surgeons hold monthly preoperative conferences with their cardiac surgery colleagues to plan the best paths forward for patients. 

Soon, Dr. Yamaguchi and colleagues will have a state-of-the-art space for performing procedures. 

“We’re developing a hybrid operating room with advanced technology to expand our endovascular surgery profile further,” he said. “We’ll be able to treat patients with less radiation and contrast, making the procedures safer for them. As a center, we’re getting to where we want to be.” 

How to Refer

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