Juan B Grau1, Cyrus E Kuschner2, Giovanni Ferrari3, Sean R Wilson2, Mariano E Brizzio2, Alex Zapolanski2, Joseph Yallowitz4, Richard E Shaw2. 1. The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey; Columbia University, College of Physicians and Surgeons, New York, New Jersey; The University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania. Electronic address: jbg2136@columbia.edu. 2. The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey. 3. The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey; The University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania. 4. The Valley Hospital, Emergency Department, Ridgewood, New Jersey.
Abstract
BACKGROUND: Ascending aortic dissections (AADs) require prompt diagnosis and surgical treatment. We present the results of implementing a multidisciplinary aortic dissection protocol on the outcomes of AAD treatment at a nonteaching hospital. METHODS: From January 2002-December 2013, 54 patients with the diagnosis of AAD were treated at our institution. Thirty-seven (68.5%) were male with a mean age of 62.3 y. Cardiogenic shock was present in 25.9% of patients. An AAD protocol, focused on educating physicians on presenting signs and symptoms, adequate triaging, and the need for immediate surgical intervention, was implemented, alongside the standardization of surgical treatment. We divided the cohort into two eras, based on AAD program's implementation in 2006, to better assess the impact of this protocol. RESULTS: Patients from the early era had significantly longer time from Emergency Department to the operating room, more postoperative occurrence of prolonged ventilation, and a longer postoperative hospital stay at 8.7 ± 8 versus 3.1 ± 2.6 h (P = 0.002), 63% versus 18% (P = 0.002), and 63% versus 18% (P = 0.002), respectively. The overall mortality for the cohort was 9.3%, decreasing from 12.5% before 2006 to 7.9% after 2006. CONCLUSIONS: The implementation of a multidisciplinary aortic dissection protocol has resulted in faster diagnosis and transport of AAD cases from the emergency room to the operating room, improving outcomes. Our data support the concept that nonteaching institutions can deliver excellent care to patients with acute aortic emergencies.
BACKGROUND: Ascending aortic dissections (AADs) require prompt diagnosis and surgical treatment. We present the results of implementing a multidisciplinary aortic dissection protocol on the outcomes of AAD treatment at a nonteaching hospital. METHODS: From January 2002-December 2013, 54 patients with the diagnosis of AAD were treated at our institution. Thirty-seven (68.5%) were male with a mean age of 62.3 y. Cardiogenic shock was present in 25.9% of patients. An AAD protocol, focused on educating physicians on presenting signs and symptoms, adequate triaging, and the need for immediate surgical intervention, was implemented, alongside the standardization of surgical treatment. We divided the cohort into two eras, based on AAD program's implementation in 2006, to better assess the impact of this protocol. RESULTS:Patients from the early era had significantly longer time from Emergency Department to the operating room, more postoperative occurrence of prolonged ventilation, and a longer postoperative hospital stay at 8.7 ± 8 versus 3.1 ± 2.6 h (P = 0.002), 63% versus 18% (P = 0.002), and 63% versus 18% (P = 0.002), respectively. The overall mortality for the cohort was 9.3%, decreasing from 12.5% before 2006 to 7.9% after 2006. CONCLUSIONS: The implementation of a multidisciplinary aortic dissection protocol has resulted in faster diagnosis and transport of AAD cases from the emergency room to the operating room, improving outcomes. Our data support the concept that nonteaching institutions can deliver excellent care to patients with acute aortic emergencies.
Authors: Nicholas D Andersen; Ehsan Benrashid; Adia K Ross; Lisa C Pickett; Peter K Smith; Mani A Daneshmand; Jacob N Schroder; Jeffrey G Gaca; G Chad Hughes Journal: Ann Cardiothorac Surg Date: 2016-05
Authors: Julia Merkle; Anton Sabashnikov; Antje-Christin Deppe; Mohamed Zeriouh; Johanna Maier; Carolyn Weber; Kaveh Eghbalzadeh; Georg Schlachtenberger; Olga Shostak; Ilija Djordjevic; Elmar Kuhn; Parwis B Rahmanian; Navid Madershahian; Christian Rustenbach; Oliver Liakopoulos; Yeong-Hoon Choi; Ferdinand Kuhn-Régnier; Thorsten Wahlers Journal: Ther Adv Cardiovasc Dis Date: 2018-10-08
Authors: Alex Bottle; Giovanni Mariscalco; Matthew A Shaw; Umberto Benedetto; Athanasios Saratzis; Silvia Mariani; Mohamad Bashir; Paul Aylin; David Jenkins; Aung Y Oo; Gavin J Murphy Journal: J Am Heart Assoc Date: 2017-03-14 Impact factor: 5.501