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Overcoming Aortic Dissection to Achieve an Inspiring Recovery

8 minute read
Matt and Kristi Schaefer with their two kids in front of the Tree of Life.

Caring for a very sick patient takes a village. In Matt Schaefers' case, the expert care he received from a wide range of Mass General Brigham specialists not only saved his life but also enabled him to return to living.

Matt, 42, a PhD infectious disease research scientist at Boston Children's Hospital and assistant professor at Harvard Medical School, is an active father of two elementary-aged children. He lives with his wife, Kristi, and their kids in Sherborn, Massachusetts.

While Matt was used to managing high blood pressure with medication, little did he know that hidden in his genetic makeup was an increased likelihood of developing a life-threatening condition called aortic dissection.

The issue came to light without warning one winter morning. Thanks to the efforts of a multidisciplinary team of Mass General Brigham experts — including vascular medicine and advanced heart failure cardiologists, anesthesiologists, neurologists, intensivists, nurses, and other staff — Matt survived and has made a remarkable recovery.

'Hit me like 10 tons of bricks'

It seemed like a typical day for Matt. He got his kids ready for school, and Kristi took them to the bus stop. Suddenly, he experienced a dramatic onset of symptoms.

"The pain in my chest and back hit me like 10 tons of bricks," he said. "It laid me out, and I knew something wasn't right."

Kristi found Matt lying on their bed. His skin was gray. A former paramedic, she sprang into action and called an ambulance to take Matt to the local emergency room (ER).

In the ER, Matt's condition rapidly got worse. He lost the ability to breathe on his own and was placed on a ventilator. An echocardiogram found a tear in the inner layer of the aorta, causing blood to rush into the walls of the artery and disrupt blood flow to his organs.

The pain in my chest and back hit me like 10 tons of bricks," he said. "It laid me out, and I knew something wasn't right.

Matt Schaefers
Mass General Brigham Patient

Matt was soon diagnosed with a type A aortic dissection. In his case, it changed the geometry of one of his heart valves. The damaged valve, which usually allows blood to flow only out of the heart, was also allowing blood to leak back in. As a result, the left ventricle flooded, leading to fluid backup in Matt's lungs.

Receiving timely care would be essential. Every hour that passes after an aortic dissection increases the risk of death by 1% to 2%. Matt was taken by Boston MedFlight helicopter to the Brigham and Women's ER.

Balancing the risks of open-heart surgery

Estimating that Matt had a less than 25% chance of survival, Matt's cardiothoracic surgeon assembled a diverse team of specialists to treat him. Surgery to repair the aortic dissection would be risky. But without surgery, Matt would die.

In order to address concerns about heart failure (when the heart does not pump enough blood to the rest of the body), Akinobu Itoh, MD, PhD, surgical director of the Brigham and Women's mechanical circulatory support program, entered the picture. One of Dr. Itoh's specialties is supporting weak hearts using heart pumps and other devices.

In the operating room, Matt's heart stopped. The team performed CPR to restart it. Then he was placed on a heart-lung machine to maintain blood and oxygen circulation on a short-term basis.

Once stabilized, Matt underwent open heart surgery led by a trio of Brigham and Women's surgeons. They found an aneurysm (a bulge in a blood vessel caused by weakened arterial walls), which they replaced with a graft.

The damaged valve also needed to be replaced. Younger patients like Matt usually receive a mechanical valve made of carbon. However, Dr. Itoh suspected that Matt would soon need a heart pump. Since the cable running from the pump to the heart cannot pass through carbon, using a mechanical valve would be impossible. Dr. Itoh chose to use a valve made of cow tissue.

"The durability of the tissue valve is limited compared with a mechanical valve," Dr. Itoh said. "But we had to make sure he could survive the next few weeks. His ventricle was very weak and needed support, so the shorter longevity of the valve was a small price to pay."

Five open heart surgeries

Matt had five open heart surgeries over a two-week period. These included procedures to insert and later remove a heart pump. He also spent time on an ECMO machine for long-term heart and lung support until he recovered.

Each surgery required anesthesia, which was overseen by another member of Matt's medical village, Luigino Nascimben, MD.

While in the cardiac intensive care unit one week after the initial event, Matt struggled to wake up from the anesthesia. A CT scan showed he had suffered several strokes. Mass General Brigham intensivist Christoph Gunther Stanislaw Nabzdyk, MD, preached calm and patience, stressing that the surgeries had been successful.

"Dr. Nascimben and Dr. Nabzdyk provided reassurance and watched over Matt," says Kristi. "They helped him move from minute-by-minute care to hour-by-hour and then eventually day-by-day."

After two weeks, Matt finally started making progress.

"Every single day, he did a little bit more," Kristi said. "One day, he could move his fingers. The next day, it was his wrist. Then his elbow. Everyone focused on these small daily wins, which were huge steps in terms of his overall recovery."

Matt's strength gradually returned until he was ready to start the next phase of his recovery: rehabilitation.

Physical and occupational therapy provide a boost

Matt stayed at Spaulding Hospital Cambridge for one month under the care of William J. Reilly, MS, OTR/L, director of inpatient rehabilitation; physical therapist Christina Lopez, PT, DPT; and occupational therapist Florence Cui, OT.

The first major hurdle was stabilizing Matt's blood pressure, which dropped sharply whenever he sat up. His care team at Spaulding tinkered with various solutions, such as changing his medications and using compression tights. Within two weeks, he took his first steps.

"Physical therapy and occupational therapy at Spaulding were amazing," Matt said. "I started with a walker, and then I got stronger and could walk on my own."

"The therapists there were incredible beyond words," Kristi added.

Matt returned home just over two months after falling ill, eager to resume activities, especially attending his children's sporting events. He took it slow at first, building in time for plenty of rest, but gradually added more to his plate.

"I'm still not completely back to normal," Matt said. "I tire quickly, but I'm getting better every day. Stairs used to be more of a challenge, but now I go up and down them with no thought at all."

Matt, who suffered no cognitive or neurological issues due to his ordeal, is back at his job at Boston Children's Hospital. Besides doing cardiac rehabilitation twice a week at Mass General Brigham, he periodically sees various specialists to confirm he's staying on track.

"I feel pretty good about where I'm at," Matt said. "There are still lingering questions and uncertainties, but I'll control what I can, try to accept what I can't and just live my life. I acknowledge the hardness of the situation, take a deep breath and go forward one step at a time."

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