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

Learn more about what makes Ochsner’s vascular and endovascular surgery services exceptional, or refer a patient.

Treating & Educating About Women’s Cardiovascular Disease

Women face numerous disparities in cardiovascular disease diagnosis and treatment relative to men, including delayed symptom detection and a tendency to receive less aggressive initial therapy. Dominique Williams, MD, a noninvasive general cardiologist at Ochsner Medical Center - New Orleans, has made reducing these differences in care her life’s work. That task takes on extra urgency in Louisiana, which ranks 43rd in the U.S. in cardiovascular disease diagnosis rate, according to the state Department of Health.

“Disparities in treatment can lead to poor outcomes, and studies have shown that women often do worse with cardiovascular disease than men,” Dr. Williams said. “One of my primary roles is to not only take care of women with heart disease, but also to raise awareness and educate other physicians on how to identify women at high risk. Once we pinpoint these patients, we need to be just as aggressive in treating them as we would be with men, and that includes treatment of pregnant and postpartum women.”

Importance of obstetric history

Women often have atypical and subtle heart attack symptoms, such as fatigue and nausea, a fact well-documented in medical literature. In addition, though, Dr. Williams finds that women tend to downplay or misattribute their symptoms, further complicating the diagnostic process. Women’s unique life factors, particularly pregnancy, add another layer of complexity.

“Cardiovascular disease can be even more difficult to diagnose in younger women because they often don’t have classic risk factors,” Dr. Williams said. “On the whole, we as clinicians don’t do a good enough job of taking women’s obstetric history and factoring conditions like preeclampsia into our evaluations. As a result, we can miss opportunities for accurate diagnosis and effective treatment.”

Dr. Williams stresses the importance of obtaining a thorough obstetric history because preeclampsia can significantly increase a woman’s heart disease risk. She recommends robust management of blood pressure and cholesterol for any woman with a history of preeclampsia, even if she is young and otherwise healthy.

Cardiovascular complications in pregnancy & postpartum

Heart failure and arrhythmias account for most of the cardiovascular complications Dr. Williams sees in pregnant and postpartum women. Patients typically seek care sooner for arrhythmias because the symptoms are more easily recognizable.

“Heart failure can be more difficult to diagnose because its symptoms, such as shortness of breath and leg swelling, overlap with those of pregnancy,” Dr. Williams said. “Clinicians often miss heart failure in the later stages of pregnancy and early postpartum period, leading to later diagnoses and, often, more severe illness.”

Dr. Williams believes some clinicians’ hesitation to prescribe medical therapy to pregnant and postpartum women contributes to cardiovascular disease’s status as a leading cause of mortality in the first year after giving birth. Effective medical therapies are available, but a relative paucity of data on their use in pregnant and postpartum women (and women in general) may dissuade some clinicians from prescribing them.

Tools for risk stratification

At the Ochsner Women’s Cardiovascular Clinic, part of the John Ochsner Heart & Vascular Institute, Dr. Williams uses advanced imaging tools to help guide treatment for some women with high cardiovascular disease risk. One example is the coronary artery calcium test, which Dr. Williams believes can, in some cases, better capture patients’ risk than other tools, such as the atherosclerotic cardiovascular disease score.

“I’ll get a CAC score for risk stratification in a woman who has nontraditional risk factors, like preeclampsia, and for whom we’re trying to determine whether we should be more aggressive in treating her for heart disease,” Dr. Williams said. “For example, we may discuss whether a statin would be appropriate even if her cholesterol is fairly well-controlled.”

According to Dr. Williams, women with unconventional risk factors are also good candidates for a cardiac PET stress test, even in the absence of obstructive coronary disease. That is because many of these women have microvascular dysfunction that can contribute to symptoms, and treating them can lower their cardiovascular disease mortality risk.

Partners in cardiovascular disease care

Intra- and interdisciplinary collaboration helps define women’s cardiovascular disease care at Ochsner. Dr. Williams and fellow cardiologist Salima Qamruddin, MD, have partnered on research investigating the use of artificial intelligence in electrocardiography screening devices, such as smartwatches, to detect asymptomatic heart disease in women. These tools could help detect ventricular dysfunction or valvular heart disease early.

Recognizing that lifestyle changes play a critical role in heart disease prevention, Dr. Williams leverages the extensive expertise and resources throughout the Ochsner system, from a comprehensive weight loss program to Ochsner Digital Medicine for managing cardiometabolic conditions, to help patients improve their health. She also collaborates with experts in the Menopause and Women’s Wellness Center and cardio-oncology program to ensure women receive the specialized care they need at every stage of life.

Leading the way into the future

Dr. Williams foresees the field of women’s cardiovascular care continuing to grow as more researchers devote themselves to studying sex and gender disparities and more women enroll in clinical trials. Ochsner will have a key role in shaping a future of greater parity in heart disease treatment.

“I envision Ochsner being a leading center in our region for holistic women’s care, where we look at menopause, pregnancy and everything else women go through, and optimize their cardiovascular health at each point,” Dr. Williams said. “I see us continuing to be involved in research in this area, including how we can use AI to drive earlier diagnoses so we can start treatments sooner. That’s where we’re headed, and we’re on the right path.”

How to Refer

Find more information about women’s cardiovascular care at Ochsner, or refer a patient.