Not many people know about this potentially fatal condition
The patient never had a single heart symptom until December 2022 when he suddenly felt excruciating pain in his jaw and back. The 74-year-old Harwich resident managed to get into the car so his wife could drive him to Cape Cod Hospital, but she ended up calling Dennis Rescue and meeting an ambulance at the Dennis Police Station. Once at the hospital, a CAT scan revealed that he had an aortic dissection.
“My first impression was should I go to Boston and the answer was you don’t have time to go to Boston,” said the patient, who asked that his name not be used. “That’s when I knew it was kind of serious.”
“The mortality rate is about 1 to 2 percent per hour when you develop an aortic dissection, said Cardiac Surgeon Saqib Masroor, MD. “So, the sooner you can get the patient in the OR, the better it is.”
An aortic dissection occurs when the inner wall of the aorta peels off from the rest of the wall, Dr. Masroor explained. This may or may not be accompanied by an aneurysm. The problem is that most people don’t know they have an aneurysm or an abnormal aorta. The most common symptom of an aortic dissection is severe chest pain going all the way to the back, like the patient had. Some people also have numbness, weakness or paralysis of the legs because of lack of blood flow to legs, or stroke-like symptoms (inability to speak or loss of consciousness) due to lack of blood flow to the brain.
When stroke-like symptoms are encountered, the condition is even more serious, Dr. Masroor said, because that means the brain is not getting enough blood and the surgical team has to work quickly before the brain suffers irreversible damage. Mortality rates are increased significantly when these unusual symptoms are present.
Treatment Depends on Location
Aortic dissection is most common in people in their 60s and 70s, but it can occur in people in their 50s as well, Dr. Masroor said. It is more common in men than women although mortality is higher in women. It can also occur in younger people who have rare congenital conditions like connective disorders, including Marfan’s Syndrome and Loeys-Dietz Syndrome. Risk factors include smoking, high blood pressure, aneurysm and cocaine use.
Treatment depends on where the dissection is located. If it is located in the descending aorta, medical treatment like blood pressure medication and control can be enough. These patients may be candidates for endovascular repair (endograft) which involves putting a synthetic graft inside the aorta through the groin artery. If dissection involves the ascending aorta, surgery can save lives, because medical therapy has consistently poor outcomes.
“An aortic dissection in the ascending aorta has very high mortality and surgery provides better results than medical treatment and blood pressure control,” Dr. Masroor said. “Ideally you have to replace the ascending aorta and sometimes the aortic arch has to be replaced too. This is one of the riskiest open-heart procedures that can be done. There is a 20 to 30 percent risk of mortality or serious complications.”
After surgery, patients stay in the hospital for five to seven days. Complete healing takes another eight to 12 weeks.
Since the surgery is such a complex and high-risk one, it is usually done at a large academic teaching hospital that has more experience with the surgery and post-operative care, Dr. Masroor said. That is only possible if the patient is stable. If the patient is unstable, like the patient in this story, it would be dangerous to try to transfer them.
The good news is that, since Dr. Masroor became chief of Cardiac Surgery at Cape Cod Hospital in December 2022, the surgeries are being done locally at CCH. He has done four surgeries for aortic dissection since he arrived. All four patients survived and are doing very well today.
“They did a great job,” the patient said. “I was very happy with it. It’s been 16 weeks and I feel great. I ride my stationary bike every day.”
