What does John O’Brien, one-half of the popular on-air radio personalities who make up WAQY’s Bax and O’Brien Show, share with movie and television stars Lucille Ball and John Ritter, Jonathan Larson who wrote the popular Broadway play “Rent,” and Albert Einstein?
They all had aortic aneurysms.
The only difference is O’Brien survived his.
What is an aneurysm?
“Aneurysms are very common and keep cardiac surgeons and vascular surgeons quite busy,” said cardiac surgeon Dr. David Deaton of the Heart & Vascular Program at Baystate Medical Center.
There are two types of aneurysms. Atherosclerosis, better known to some as hardening of the arteries, can lead to an aneurysm in the abdomen when there is a narrowing of the arteries because of plaque and other substances building up there. Atherosclerosis is associated with smoking, high blood pressure and diabetes. Aneurysms in the chest area are usually the result of a weakness of the tissues of the aorta. High blood pressure causes those tissues to stretch, eventually leading to an aneurysm.
O’Brien had a thoracic aortic aneurysm. His involved the ascending aorta, which is the very first part of the aorta after it exits the heart to carry blood to the entire body. The surgery involved opening the chest and going through the breastbone to reach the dilated segment of the aorta, excise it and replace it with a fabric tube called a graft.
Twice the normal size
“John’s aortic aneurysm was almost twice the normal size of the aorta and put him at risk for a number of different complications, chief of which is an aortic dissection. An aortic dissection is a tear on the inside of the aorta, which oftentimes is a lethal event,” said Dr. Deaton.
O’Brien’s health concerns began six years ago when he was operated on by Dr. Richard Arenas of the Baystate Regional Cancer Program to remove a large spot on his back, along with a number of lymph nodes under his left arm. Tests showed he had stage 3 melanoma and he was enrolled in a clinical trial at Baystate involving the drug interferon. Unfortunately, the cancer later progressed to his lungs and he was diagnosed with stage 4 melanoma. John’s oncologist, Dr. John McCann of the Baystate Regional Cancer Program, placed him on a new immunotherapy drug called pembrolizumab, which is marketed under the name Keytruda. Not a chemotherapy or radiation therapy, it is an immunotherapy that works with your immune system to help fight the cancer.
“They found my aortic aneurysm two years ago during a routine scan to follow the cancer in my lungs and monitor the progress of the drug they were giving me,” O’Brien said.
Waiting for the outcome
At the time it was found, Dr. Deaton said it still wasn’t known what O’Brien’s outcome was going to be from his melanoma surgery.
“So, it wasn’t reasonable to ask John to go through such a big operation until we were able to determine his prognosis from the melanoma. We monitored John closely through those chest CT scans for any change in the size and growth of the aneurysm, which we knew was growing slowly. From those scans, we were able to determine that there were no major changes to the aneurysm to cause us any immediate concern. However, once we heard from Dr. McCann that he was relatively cured of the melanoma with no active disease for a long time, it seemed to be appropriate then to fix the aneurysm with it now being the only thing that could adversely affect his health,” said Dr. Deaton.
After a long discussion between O’Brien and his cardiac surgeon, it was decided that he would undergo the operation in early January.
Confident in outcome
“Relative to many people who have this type of aneurysm, John’s operation represented low risk to him since he was fairly healthy at the time and having no symptoms from the aneurysm. I was confident that I could perform the operation safely on John to reduce any risk of future problems from the aneurysm,” said Dr. Deaton.
Still, O’Brien said he was more worried about the aneurysm surgery than his previous cancer operation.
“I knew that I would have more pain after this surgery, but even more so there was the fear factor of side effects from the surgery, such as suffering a stroke. That was on my mind because I knew actor Bill Paxton had died not too long ago from a stroke following surgery for an aortic aneurysm,” he said.
Surgery can take anywhere from 2-4 hours. O’Brien’s operation was about three hours.
A successful operation
“The aneurysm involved only a limited amount of the aorta. John did very well and we expected him to do well because he was low risk, meaning his operation wasn’t an emergency, and it didn’t involve replacing an extensive amount of the aorta,” said Dr. Deaton.
O’Brien was put on the heart-lung machine, which took over the function of the heart and lungs while his heart was stopped.
“What happens is that blood normally flowing through the aorta is diverted so that we can remove the dilated segment of the aorta and repair it. All of this occurs while the blood goes through the heart-lung machine, which adds oxygen to the blood from the heart and pumps it back into the body, all while bypassing the side of the aorta we are working on,” said Dr. Deaton.
Asked how he felt after waking up in the Cardiac Intensive Care Unit after the operation, O’Brien put his comic hat on.
Waking up afterwards
“I felt like I had been hit by a truck while standing in the middle of the highway, which knocked me over the guardrail onto the railroad tracks where I got run over by a train and somehow survived. I was then placed in an ambulance to be brought to the hospital and it was broadsided and pushed through a barrier separating the road from a body of water and I almost drowned. But, today I feel great,” he laughed.
One of the biggest challenges to recovery is the sternotomy, which is the incision where surgeons divide the breast bone.
“This can cause a great deal of discomfort during their recovery. The other is getting over the effects of the use of the heart-lung machine. The heart-lung machine is primed with saline, which then mixes with the patient’s blood and dilutes it. So, after coming out of open heart surgery, patients have a profound case of anemia and that causes them to feel very tired for some time,” said Dr. Deaton, who noted recovery is usually a three-month period for most people.
“There are some days where I feel perfect and great, which is most of the time, then hit a wall later in the day. But, my recovery is coming along faster than many with the same operation. One thing I do miss is getting on my StairMaster. Right now I have to shuffle along on a treadmill,” said O’Brien, who has returned to his longtime radio show.
Not a second thought
When it came to undergoing the operation, O’Brien said he didn’t give it a second thought.
“I’ve said this before, I’m not a second-opinion type of guy. I have a lot of faith in everybody at Baystate Medical Center,” said O’Brien.
Would he recommend the operation to anyone else needing it?
“I would tell them not to sweat it, that everything would be fine,” said O’Brien.
A reassurance for patients
Dr. Deaton has his own reassurances for patients.
“I tell them that we do this a lot. At Baystate Medical Center we perform anywhere from 3-4 open heart operations a day (Monday through Friday) and most of the time they don’t push the limits of our ability to stop the heart and support the body with devices like the heart-lung machine,” he said.