Published on February 17, 2012

Heart Patient: “They call me a miracle”

Complex surgery at Genesis mends aortic dissection

Rex Concannon, 55, blamed his heartburn on the pizza he had just eaten with co-workers.

When his upper back began to ache, he figured he must have slept on it wrong.

The symptoms that began on a Thursday continued into the weekend, but he decided to spend a couple of nights on his boat anyway. He didn’t give his discomfort much thought. That is, until he mentioned it to a friend on a nearby boat Sunday morning during his morning coffee.

The friend, a veteran heart surgery patient at Genesis, insisted he go to the Emergency Room.

That persistence probably saved Rex Concannon’s life.

“I kept thinking to myself, ‘This can’t be serious. I’ve had heartburn before. Lots of people have heartburn,’ “ says Concannon of Coal Valley, Ill.

He went to the Emergency Department at Genesis Medical Center, Davenport and was surprised to learn his condition was very serious.

A CT scan detected an aortic dissection, an uncommon but often lethal tear in the body’s largest artery. He had the most severe kind -- Type A, a tear located next to the heart. The mortality rate is high.

Torn aortas are repaired at Genesis Medical Center, Davenport, named by Thomson Reuters as one of the nation’s Top 50 Cardiovascular Hospitals in 2011.

Before he knew it, Concannon was introduced to Genesis heart surgeon Nicholas Augelli, M.D., and told he needed immediate open-heart surgery.

“Dr. Augelli didn’t pull any punches. When I asked him my chances for survival, he told me 20 percent,” Concannon says. “I was calm; I think I was in shock.”

A tear in the aorta

Aortic dissection occurs when a tear develops in the inner layer of the aorta, the large blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate or dissect. If the blood-filled channel ruptures through the outside aortic wall, the aortic dissection is often fatal.

“Aortic dissection usually creates a spiral sort of tear above the aortic valve,” Dr. Augelli explains. “Rex had a tear in his aorta that had to be repaired right away because there was a high risk of rupture.”

During surgery, a heart-lung machine temporarily took over for the work of Concannon’s heart and lungs and allowed Dr. Augelli to operate on his motionless heart.

Dr. Augelli performed more than seven-and-half hours of complex surgery. He replaced the root and proximal ascending aorta with a textile tube graft that contained a prosthetic valve. He then re-implanted the coronary arteries into the graft.

Concannon didn’t know it, but his own aortic valve had suffered damage due to an aortic insufficiency. During the surgery, his faulty valve was replaced with a mechanical one.

“We had to reconstruct the entire outflow tract of the heart,” Dr. Augelli says.

At a recent appointment, Dr. Augelli used a model of a heart, tube graft and prosthetic valve to explain to Concannon the extent of his surgery.

“The graft is made of Dacron, a synthetic plastic also used to make sails for racing yachts. It’s a waterproof, high-textile strength material. It doesn’t stretch too much over time, so it’s reliable,” Dr. Augelli says.

Because of Concannon’s young age of 55, he received a mechanical valve instead of one made of animal tissue. “A tissue valve will fail faster in younger people because of the increased calcium metabolism,” Dr. Augelli explains. “With someone in Rex’s age group, you would expect a pig valve to only last about 15 years. Rex’s mechanical valve can last 400 years, so his lifetime is not affected by the wear and tear of the valve.”

Concannon was back at work five weeks after surgery. He is grateful for his surgeon’s talent and his friend’s insistence that he get to the hospital.

“They call me a miracle. If it wasn’t for the guy in front of me in the other boat insisting I get to the hospital, I probably wouldn’t be here. He’s a heart patient at Genesis and was very, very adamant that I get my symptoms checked out. I was kind of cocky, saying ‘Sure, I’ll get you a doctor’s slip.’ But as it turns out, it was a good thing I got to the hospital when I did.”

Symptoms

Aortic dissection also took the life of TV star John Ritter in 2003. Since Ritter’s death, his widow has advocated for greater awareness about aortic dissection.

“Symptoms of aortic dissection may mimic those of other diseases, often leading to delays in diagnosis,” Dr. Augelli says. “However, when an aortic dissection is detected early and treated promptly the chance of survival greatly improves.”

Acute aortic dissection causes sudden chest pain and can often be confused with a heart attack. The pain is described as very severe and tearing; it’s associated with a cold sweat. The pain may be localized to the front or back of the chest. Typically the pain moves as the dissection gets worse.

“Rex had vague symptoms. It wasn’t until hours later that he had a CT scan that showed an aortic dissection,” Dr. Augelli says. “John Ritter went to a very famous hospital and also showed up with vague symptoms. He was checked out and sent home. He later presented again to the hospital. His aorta ruptured, he collapsed, and he died.

“Sometimes it’s very difficult to make the diagnosis, especially if the aortic dissection is just in the process of beginning.”

Concannon feels lucky to be alive. He has had to adjust to having a mechanical valve moving inside his chest. “Sometimes I feel like I sound like a Timex,” he says, “but I’m doing everything I used to do and doing it better.”

He is grateful to the Genesis caregivers who saved him.

“The people who cared for me treated me like a king,” he says. “I can’t say enough about my experience at Genesis -- from Dr. Augelli and his team, the staff in the surgery room to the nurses at Genesis. They were all fantastic.”

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