Skip to cookie consent Skip to main content

High-Volume Expertise: Key to Successful Recovery from Aortic Dissection

Contributor Dr. Isselbacher
9 minute read

When managing complex medical conditions, experience is key. Research consistently shows that having "high-volume expertise"—meaning extensive experience in performing specific procedures or treating certain conditions—leads to better results. 

In Melody Morse's case, Mass General Brigham's high-volume expertise in surgically repairing type A aortic dissections saved her life. 

A fifth-grade teacher from North Berwick, Maine, Melody leads an active lifestyle, eats a healthy diet, and rarely has anything more than a cold. But one December morning, a sudden health scare turned her world upside down. Within 24 hours, she found herself in an emergency room (ER), was airlifted to Boston, and underwent a grueling, lengthy operation. 

"Melody had an expert cardiac aortic surgeon and an expert vascular aortic surgeon who work together all the time on cases like this," said Mass General Brigham cardiologist Eric Isselbacher, MD, MSC, co-director of Mass General's Thoracic Aortic Center. "The surgeons decided together on what steps to take and in what order to take them, and that helped her have the optimal outcome." 

The first signs of aortic dissection

While driving home alone from an appointment, Melody, then 60, abruptly felt intense pain in her jaw. By the time she pulled over to the side of the road, the pain had turned into numbness in her legs and tightness in her chest. She called her adult son Sam, who in turn called 911 after arriving at the scene.

By the time an ambulance arrived, Melody felt fine. She wasn't even sure she needed to visit a hospital. However, the emergency medical technicians convinced her to go in for further evaluation. 

Melody was taken to the ER at Wentworth-Douglass Hospital, a Mass General Brigham community hospital in Dover, New Hampshire. Within minutes, a CT scan revealed a type A aortic dissection. This life-threatening condition involves a tear in the lining of the aorta, the largest artery in the body. 

Unbeknownst to her, Melody had an aortic aneurysm, which had put her at increased risk for developing aortic dissection. An aneurysm is a bulge in a blood vessel caused by weakened arterial walls that no longer stand up to the pressure of pumping blood. An aortic aneurysm is when this bulge occurs somewhere within the aorta, the largest artery in the body. 

"This is common—many patients don't realize they have an aortic aneurysm until they experience aortic dissection," Dr. Isselbacher said. "Type A aortic dissection puts the patient at high risk of aortic rupture, which can lead to immediate death. The faster you can get them to the operating room to repair their aorta, the lower the risk of adverse outcomes." 

The medical team arranged for Melody to be airlifted to Mass General in Boston, where she could receive highly specialized care from an expert, multidisciplinary heart team.

"I am very thankful to Edward Williams, MD, the ER physician at Wentworth-Douglas who called Mass General," Melody said. "His fast action probably saved my life." 

Malperfusion makes surgery even more challenging

In treating aortic dissection, time is critical, and Mass General works to minimize any delays in care. Patients bypass the ER and go directly to the operating room, where the surgical team is ready to begin the operation right away. 

Early in the procedure, Mass General Brigham cardiac surgeon Arminder Jassar, MBBS, co-director of the Thoracic Aortic Center, replaced the dissected ascending aorta and the site of the initial aortic tear with an artificial graft (tube) to prevent aortic rupture. He also tried to repair Melody's aortic valve. However, when this proved impossible, he replaced the aortic valve with a biological prosthetic one.

Next, Dr. Jassar turned his attention to the right coronary artery, which supplies blood to the underside of the heart. The dissection tore apart the opening of the right coronary artery, so he had to perform coronary artery bypass grafting (CABG). In CABG, a healthy artery or vein taken from elsewhere in the body is grafted (connected) to the diseased coronary artery. This creates a new path for oxygen-rich blood to flow around a blockage and reach the heart.

As the operation progressed, it became clear that despite the successful repair of her ascending aorta, Melody still had malperfusion (a vascular complication) of her left kidney and both her legs. That's when Mass General vascular surgeon Jahan Mohebali, MD, MPH, stepped in. He placed one covered stent into Melody's left renal artery (which carries blood to the left kidney) and two stents in each of her iliac arteries (which carry blood to the legs), restoring normal blood flow. 

The surgery, which lasted 12 hours, was successful in addressing all of the complications that arose from Melody's aortic dissection. 

"In this case, having an experienced cardiac surgeon like Dr. Jassar wouldn't have been enough," Dr. Isselbacher said. "We also needed an experienced vascular surgeon like Dr. Mohebali to handle the second part of the surgery."

Watching for potential complications post-surgery

The next afternoon, Melody woke up from surgery in the cardiac surgical intensive care unit (ICU). Sam, her husband Steve, and her daughter Sarah were all there to greet her. They had been keeping Melody's son Josh, who lives in Arizona, up to date every step along the way. 

In the ICU, Melody met Dr. Isselbacher, who has served as her cardiologist ever since. 

"Following surgery for aortic dissection, it's important to have an experienced ICU team that knows about potential complications and can monitor the patient carefully," Dr. Isselbacher said. "We're vigilant about observing the patient in the ICU and then on the cardiac surgery floor. And then, before the patient is discharged, we do another CT scan to make sure everything looks okay." 

Melody stayed at Mass General for 17 days. She was pleasantly surprised by the personalized care she received.

Melody was able to go home before Christmas, feeling exhausted but grateful to be alive. After regaining some strength, she completed eight weeks of cardiac rehabilitation at Wentworth-Douglass. 

Three months after surgery, Melody returned to the classroom, much to her students' relief. To mark the first anniversary of the surgery, she and Steve climbed Mount Major, a 1,786-foot mountain in New Hampshire. Since then, she's enjoyed many more hikes with her students, family, and friends.

"I'm feeling really strong. I'm not completely back to where I was physically, but I'm getting there," she said. "It's the speed factor that I'm trying to get used to—living at a slower pace. But I definitely appreciate things more. I'm thankful every day to be outside, to be at work, to see and talk with family." 

The gift of a normal life

Dr. Isselbacher said that Melody can expect to continue improving. "Not lifting heavy objects is her only major restriction—she shouldn't be bench pressing or moving refrigerators up the stairs," he explained. "Short of that, she can travel the world and live her life as normally as anyone else." 

Melody now monitors her blood pressure at home to ensure it stays well-controlled. During her yearly visits with Dr. Isselbacher, her blood pressure is checked and she undergoes CT scans to make sure her aorta is stable. 

In speaking with Melody and Steve shortly after the surgery, Dr. Isselbacher emphasized how lucky Melody was to survive such a serious condition.

"With a complicated case like Melody's, the decision making, surgical intervention, and postoperative management are all best done by a multidisciplinary aortic team of experts that truly performs as a team," Dr. Isselbacher said. "That's what we're able to offer at Mass General Brigham."


Learn about Mass General Brigham Heart services