The Kuster Family

Patient insists on Hospital for procedure

Fred Kuster, a vibrant father of a sixyear- old, looked to his upcoming trip to Williamsburg, Virginia, with as much anticipation as his son, Max. It was more than a week-long vacation; it was a celebration of getting back the life the 44-year-old had prior to his second heart surgery in June.

In 1996 Mr. Kuster experienced an acute aortic dissection, a condition in which high blood pressure caused the inner lining of his aorta to separate from the outer lining, creating two paths of blood flow: true and false channels to his vital organs. Three days earlier he'd joked with co-workers that if the Yankees won the World Series that weekend, he'd call in sick on Monday. Little did he know that he wouldn't return for four months.

While relaxing that weekend, he felt a pain in his chest he could only describe as a knife stab and something ripping. After calling 911, he was transported to a local emergency room. He was quickly diagnosed and transferred to Winthrop for emergency open-heart surgery to replace a damaged valve, repair his aorta and replace his ascending aorta. This timely transfer saved his life.

Fast forward nine years. This June, while at work, he felt a sharp back pain. Believing he pulled a muscle, he brushed it off. When he got home and the pain didn't improve, his wife took initiative and called their primary care physician. The pain was radiating with every beat of his heart.

Mr. Kuster's doctor told him to get to the hospital fast—his life depended on it. He went straight to Winthrop.

"Dr. Kofsky saved my life the first time, and he did it again," he said.

A CAT scan showed Mr. Kuster suffered from a thoracic aortic aneurysm, a serious condition that if the vessel burst or ruptured, it could cause internal bleeding; if left untreated, even death.

"His entire aortic arch was dissected and at risk for dilation and rupture," explained Edward Kofsky, MD, Winthrop's Director of Minimally Invasive Cardiothoracic Surgery.

A day after Father's Day, Dr. Kofsky and his highly skilled team placed Mr. Kuster under circulatory arrest to slow his blood flow before replacing his ascending aortic arch with a custom-fit fabric branched tube. This special graft, which is then connected to the aorta, included attachments for all the vessels supplying the brain and upper extremities.

The team also left an "elephant trunk," an extra intravascular graft length, inside the descending aorta to allow for future reconstruction of the remaining defective aorta if necessary.

"The procedure certainly is an unusual operation in that it is not frequently needed and allows us to shorten the time the patient is under cerebral and circulatory arrest," explained Dr. Kofsky. "A center of excellence with highly skilled teams and advanced technology, Winthrop is deft at performing this difficult, cutting- edge surgery. We literally spent hours of intense, thorough planning to avoid possible pitfalls, overcome any logistical issues and pave the way for Mr. Kuster's smooth recovery." Although Mr. Kuster spent seven days at Winthrop recovering, he was off ventilation and walking around with the help of a physical therapist just a day after his surgery. Mr. Kuster never needed the bed, lift and other equipment his wife rented, but she still worried about his fast recovery. Two months later, he was anxious to get out of the house. He was ready to get his life back to normal.

"I can't wait to get out on the greens and play a round of nine holes," he told his wife, Cheryl. She looked at him with concern and gently reminded him he had to take it easy.

"I'm the one who worries, and he's more laid back about it all, but he's doing so well, I'm okay," she said.

The reality of it all struck Mr. Kuster. "I could have been in a car or a plane when this happened," he said.

"I was very lucky. It's been a wake-up call to improve my health." Now, he's watching his diet and exercising to strengthen his heart, which has to be monitored every six months.

His efforts have resulted in a reduction in his blood pressure and medication. Dr. Kofsky told him he didn't have to see him for three months—he's doing so well.

"I am happy I got through it all. I'm on a good path now," he said. "There's nothing I can't do at this point." Dr. Kofsky agrees: "He has a full life to lead."