On Dec. 31, 2014, when world-renowned pianist Menahem Pressler stepped off the stage after performing with the Berlin Philharmonic, he didn’t realize the pain in his left side could kill him.
Just eight days later, at Massachusetts General Hospital, the 91-year-old underwent a relatively rare procedure to repair a life-threatening aneurysm in his thoracic aorta. He had been referred to Mass General vascular surgeon Virendra Patel, MD, MPH, after surgeons in Indianapolis, Indiana, near his hometown of Bloomington, told him traditional open heart surgery was too risky.
In recent years, Dr. Patel has initiated a new procedure known as a fenestrated thoracic endovascular aortic stent graft (f-TEVAR). f-TEVAR is a less invasive option for patients who have thoracoabdominal aneurysms who are not considered strong enough to endure the stress of open surgery. Dr. Patel is one of only a handful of U.S. doctors performing these very precise grafting procedures and only one of a few surgeons worldwide who can perform both open and endovascular thoracoabdominal aortic aneurysm repair.
Negotiating No Man’s Land
An aneurysm in the aorta is a life-threatening condition since the aorta is the largest blood vessel, carrying oxygen-rich blood away from the heart and to all parts of the body. Aneurysms occur when the artery wall weakens and abnormally bulges because of damage caused by infection/inflammation, injury, dissection or atherosclerosis. Aneurysms become dangerous when they create pain, compress nearby organs, leak or cause the aorta to split or rupture.
Abdominal aortic aneurysms affect nearly 30,000 people in the United States each year while thoracic (chest) aortic aneurysms affect approximately 15,000 people. While surgeons have had great success repairing aneurysms with stents in the abdominal or thoracic (chest) aorta, using stents in the thoracoabdominal aorta is rare because such stents need to accommodate important blood vessels to the intestines and abdominal organs.
“The thoracoabdominal aorta has been a no man’s land for stent grafts except in rare cases,” Dr. Patel explains. “That’s partly because the stents simply haven’t been commercially available to deal with the complex anatomy of this region. We need to do more clinical testing on the long-term patient outcome from this type of procedure versus open surgery.”
Feeling Absolutely Safe
Dr. Patel, who has seen demand for these procedures increase, is looking for funding to conduct a clinical study under the auspices of the Food and Drug Administration. This study will allow him to work with a company that will manufacture the stents and also permit him to track each patient’s recovery.
Mass General is one of only a few medical centers in the US that can offer expertise in both open surgery and fenestrated thoracic endovascular aortic stent graft, but Dr. Patel is the only surgeon at Mass General who performs this particular procedure.
“Dr. Patel met us when we arrived at the hospital,” recalls Edna Pressler, the pianist’s daughter. “He explained exactly what the procedure was, the measurements he needed to take and he made us both feel absolutely safe.”
Precise Aneurysm Measurement
Once the decision is made to go ahead, Dr. Patel customizes a commercially available stent to fit the individual. After a CT scan identifies the exact location and size of the aneurysm, Dr. Patel makes a series of precise measurements to ensure the stent fits properly within the aorta. It must contain the aneurysm and prevent rupture, but also allow for openings (fenestrations) to let the aorta branch into the body’s other arteries.
While the procedure is technically exacting, Mr. Pressler was struck by how sensitive Dr. Patel was to his desire to get back to the piano.
“Dr. Patel not only cares for, but cares about his patients,” Mr. Pressler says. “He operates with love, with knowledge, and with a sense of confidence that he will succeed. He showed so much joy at my recovery.”
Mr. Pressler’s determination to remain active, along with a very strong family support system, made a critical difference in his recovery, Dr. Patel says.
A Surgeon’s Gift of Healing
Until the graft procedure, Mr. Pressler had been a very active concert pianist and teacher, flying around the world to perform with orchestras, chamber ensembles and as a soloist. During his more than 50-year tenure with the Beaux Arts Trio, he recorded nearly the entire piano chamber music repertoire, and has been lauded for his remarkably expressive approach to music.
“God gave me the gift of music, and he gave Dr. Patel the gift of healing. The world is a better place for having a man like him in it.”
Less than six months after his graft, Mr. Pressler performed an entirely new repertoire in London, and he has continued to perform and lead master classes internationally.
“For me, to be able to continue the way of life I love – to be an artist and perform – is such a gift,” Mr. Pressler says. “God gave me the gift of music, and he gave Dr. Patel the gift of healing. The world is a better place for having a man like him in it.”
Private philanthropy has been essential to Mass General’s success in identifying and testing new therapies, and it will play a critical role in our ability to improve our approach to repairing and caring for the body’s most important organs.
To learn more about how you can support Dr. Patel’s research, please contact us.