Man beats odds, emergency stent plugs burst aorta

When Robert Oberg got the news more than a decade ago that he had a bulging aorta that was likely to burst, he decided to take his chances that it wouldn’t.

“At Stanford they told me my chances were about fifty-fifty with surgery. And it was the same without. I figured I’d just take my chances and wait until technology caught up,” said the 56-year-old Fresno man who makes his living driving a snow plow.

Lucky for him, when the main artery to his heart did rupture he was close to Community Regional Medical Center and cardiac surgeon Peter Birnbaum. Dr. Birnbaum is the only Valley doctor currently performing emergency stent graft placements via catheterization rather than the traditional open chest surgery.

“Mr. Oberg knew he was a walking dead man for years,” said Dr. Birnbaum. “Most of these patients die…When the aorta tears, it’ll bleed like a fire hydrant running in your chest. Some people will make it into the hospital for surgery because the walls of the aorta are held together with just a thin membrane.”

Weeks after Oberg’s recovery, Richard Holbrooke, the U.S. special diplomatic representative for Afghanistan and Pakistan, died on Dec. 13 from the same condition after undergoing 20 hours of surgery in a Washington D.C. hospital. Aortic dissection – a tear that causes blood to flow between the layers of the artery – has a more than 80% mortality rate. And even those who make it, often face painful weeks of recovery from having their chest cracked open and an incision from the middle of the back all to way around to just under the left pectoral muscle.

“Just two years ago I had been putting patients on a heart-lung machine, opening them up and sewing in the stent to repair the aorta,” said Dr. Birnbaum who is medical director at Community’s Fresno Heart & Surgical Hospital and also performs cardiac trauma surgery at Community Regional. “But now we can snake a catheter up the femoral artery and deploy the stent in a way similar to how we do other cardiac stenting.”

Dr. Birnbaum trained to do the emergency stenting procedure after seeing so many patients coming in with that injury to the only Level 1 trauma center between Sacramento and Los Angeles. “I learned this procedure because we’re a regional trauma center and it’s a common injury in automobile accidents. The aortic tear happens when there’s a blow to the chest. In fact, it’s the most common way people die from car accidents.”

“When Mr. Oberg came into our ED, he was in bad shape and in shock,” described Dr. Birnbaum. “He had two feet in the grave when I took him into the operating room. I assembled the whole crew right away because we knew what we were dealing with.”

Oberg knew too the minute his bulging aorta tore. “I’m a huge 49ers fan and I was sitting watching the playoff game,” he said. He felt a searing pain in his chest and knew his odds were up.

“I was by myself but I managed to call an ambulance and tell them my aorta ruptured. I knew exactly what it was,” Oberg said. “If you’ve ever felt a ruptured aorta, you’d know. It will drop you.”

Dr. Birbaum said normally it drops people into a grave. “Mr. Oberg’s been our most seriously ill patient, no doubt about it. He had a stormy course pre-op, but he’s so grateful to be alive.”

Oberg agreed, “Dr. Birbaum definitely saved my life. I’m glad he was there when I came in.”

This story was reported by Erin Kennedy. She can be reached at ekennedy@communitymedical.org.