Saving This Patient Took Two Skilled Surgeons & One Amazing Team Effort
At age 63, Lionel Warren had never been so busy. He worked 12-hour days as a production manager for a manufacturing plant in New Jersey. In his off hours, he liked to hit the gym or spend time with his girlfriend, Petericia. He tended to dismiss the day-to-day aches and pains. He even pushed past occasional chest pains. But when a painful lump the size of a softball emerged at the base of his neck in September 2019, he knew it was time to see a doctor.
In the exam room of Aubrey C. Galloway, MD, the Seymour Cohn Professor of Cardiothoracic Surgery, Warren’s mysterious lump pulsated like a balloon being squeezed and released rhythmically. Even Dr. Galloway, an internationally renowned heart surgeon who’d built his reputation on tackling the toughest cases, was astonished by the mass. “‘Wow, that’s your aorta that you are feeling, there in your neck,’” he recalls saying to Warren. “It could have burst at any moment.”
Dr. Galloway recommended surgery right away.
Warren had faced down emergency surgery four years earlier after experiencing a tear of the inner wall of the upper section of the aorta, the body’s main artery. Aortic aneurysm, linked to uncontrolled high blood pressure, or hypertension, and most common among men around his age, causes blood to flow between the wall’s layers, forcing them apart. If left untreated, the wall can fatally rupture. Aortic tears like Warren’s cause 10,000 deaths annually.
A surgeon at a New Jersey hospital had replaced the damaged section with a polyester tube but not without complications: heavy bleeding forced doctors to keep Warren’s chest open postsurgery, and subsequent infections led to a three-month hospital stay, including a lengthy stretch on a ventilator. “They almost lost me twice,” says Warren.
Warren’s recovery was long, but he eventually regained his stamina. Then the thumping softball appeared. His cardiac surgeon in New Jersey examined the scan and then said, “Go to Dr. Galloway. He’s the best. You’ll be in good hands.”
Repairs of the upper section of the aorta are extremely complex, requiring advanced surgical expertise and, often, strong collaboration between cardiothoracic and vascular surgeons. NYU Langone offers precisely that: Dr. Galloway, along with his clinical partner, vascular surgeon Thomas Maldonado, MD, co-directs the Center for Complex Aortic Disease, which is among the busiest of its kind in New York City. They lead a team of doctors, researchers, and fellows who meet regularly to plan procedures and ensure optimal patient outcomes.
It’s a model that routinely attracts daunting cases, but Warren’s would push the boundaries. His aortic wall had weakened at the original surgical repair area, causing blood to pool in a pouch, a condition known as a pseudoaneurysm. The probable cause was an infection of his prior graft, which would have to be removed as well. Repairing it would require a lifesaving procedure so complex and risky that most medical centers would refuse to attempt it.
Dr. Aubrey C. Galloway, co-director of the Center for Complex Aortic Disease, likened the eight-hour operation to repair Lionel Warren’s aorta to “jumping out of an airplane, having someone throw a parachute to you, grabbing it, putting it on, and opening it before hitting the ground.”
Dr. Galloway’s team dove in. On October 8, 2019, they embarked on an ambitious surgical plan. Since it would be virtually impossible to keep the engorged mass from bursting during the surgery, blood flow would have to be stopped temporarily. The 8-hour operation began by lowering Warren’s body temperature to 63°F and packing his head in ice to prevent brain damage. After repairing the torn aorta, Dr. Galloway removed the infected graft from the previous surgery and replaced the aorta from the heart up to the blood vessels leading to the head and arms. This cleared the path for Dr. Maldonado, a nationally recognized expert in minimally invasive techniques, who planned to repair a second aneurysm in the upper left chest after Warren had recovered from the surgery. Dr. Galloway likened the operation to “jumping out of an airplane, having someone throw a parachute to you, grabbing it, putting it on, and opening it before hitting the ground.”
Nine months later, Dr. Maldonado tagged in to finish the repairs. First, he completed an open bypass, connecting two arteries between the neck and the left arm to ensure healthy blood flow following the subsequent aortic aneurysm repair. Two days later, he performed minimally invasive endovascular surgery, threading a catheter through Warren’s femoral artery and, using X-ray guidance, navigating to the damaged area of the aortic wall. There, he inserted a fabric-and-metal device called a stent graft to seal it off. Warren was discharged a few days later.
“Together, Dr. Galloway and I were able to repair something that seemed almost unfixable, using a combination of techniques,” says Dr. Maldonado.
With a now-healthy aorta and a new lease on life, Warren is back to his robust schedule: working, walking two to three miles a day, doing pushups. “The doctors say I’ve got to 100 now,” he says, “and I don’t want to miss out on anything.”