DeTurk, Stephen

Mehta, Sanjay, MD

Misselbeck, Timothy, MD

Phillips, Theodore, MD

Singer, Raymond, MD

Szwerc, Michael, MD

Szydlowski, Gary, MD

Wilson, Matthew

Wu, James, MD

English

Misselbeck, Timothy S

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryTreatment of Acute Aortic Dissection at aCommunity Hospital: A 10 Year Review ofOutcomes.Timothy Misselbeck MDLehigh Valley Health Network, Timothy_S.Misselbeck@lvhn.orgStephen DeTurkLehigh Valley Health NetworkMatthew WilsonLehigh Valley Health Network, Matthew.Wilson@lvhn.orgTheodore Phillips MDLehigh Valley Health Network, Theodore.Phillips@lvhn.orgMichael Szwerc MDLehigh Valley Health Network, Michael_F.Szwerc@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/surgeryPart of the Cardiology Commons, Other Medical Specialties Commons, and the SurgeryCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtMisselbeck, T., De Turk, S., Wilson, M., Phillips, T., Szwerc, M., Mehta, S., Szydlowski, G., Singer, R., & Wu, J. (2011). Treatment ofacute aortic dissection at a community hospital: A 10 year review of outcomes. Poster presentation.Misselbeck, T., De Turk, S., Wilson, M., Phillips, T., Szwerc, M., Mehta, S., Szydlowski, G., Singer, R., & Wu, J. (2012, March).Treatment of Acute Aortic Dissection at a Community Hospital: A 10 Year Review of Outcomes. Poster presented at The Houston AorticSymposium: Frontiers in Cardiovascular Diseases, the Fifth in the Series, Houston, TX.AuthorsTimothy Misselbeck MD, Stephen DeTurk, Matthew Wilson, Theodore Phillips MD, Michael Szwerc MD,Sanjay Mehta MD, Gary Szydlowski MD, Raymond Singer MD, and James Wu MDThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/surgery/28L e h i g h  V a L L e y  h e a L t h  N e t w o r ktreatment of acute aortic Dissection at a Community hospital: a 10 year review of outcomes.Timothy Misselbeck MD, Stephen DeTurk, Matthew Wilson, Ted Phillips MD, Michael Szwerc MD, Sanjay Mehta MD, Gary Szydlowski MD, Raymond Singer MD, James Wu MD Department of Surgery, Division of Cardiothoracic Surgery, Lehigh Valley Health Network, Allentown, PennsylvaniaBaCkgrouNDAn aortic dissection is a potentially life threatening condition. A dissection forms when a tear occurs in the intima, the inner layer of tissue in the aorta. Blood flows through the tear causing the separation of the intima and media causing an aneurysm. Using the Stanford classification system, a type A dissection occurs in the ascending aorta and a type B dissection occurs in the descending aorta.  MethoDData consisting of both type A and B aortic dissections were queried from the Lehigh Valley Health Network’s database. This resulted in 208 patients from 2000 to 2010. These 208 patients (ages 28-95), 89 were documented as having a type A dissection and 119 having a type B dissection. These categories were further separated based on whether the dissection was surgically or medically managed and the outcome.resuLtsOf the 89 patients who were diagnosed with a type A dissection, 68 were managed surgically and 21 medically. 15 patients expired, 22.06%, who were managed surgically. 7 patients treated medically, 33.33%, were pronounced in-hospital. Of those diagnosed with a type B dissection, 18 were treated surgically and 101 medically. Surgically, 2 patients, 11.11% expired during their stay. 11 patients were pronounced, 10.89%, who were treated medically during their stay. Hypertension and unstable angina were found to have the highest incidence rate in patients admitted. Atrial fibrillation and acute renal failure were among most prevalent complications.Table 1. DemographicsVariable (n=206) %Age ≥ 70 105 0.510Gender (F) 79 0.380TyPe A 87 0.422Surgical 66 0.759Non-operative 21 0.241Prohibitive risk 12 0.571Palliative care 4 0.190Transferred 3 0.143AMA 1 0.833Death before surgery 1 0.833TyPe B 119 0.578Immediate surgery 21 0.176Medical Therapy 98 0.824Table 2. In-hospital complications in patients  with type A dissectionComplications No.Incidence overall (n=87) (%)Acute Renal Failure 23 26.43Stroke 16 18.39Surgical treatment (n=66) (%)Acute Renal Failure 22 25.28Stroke 15 17.23Non-Surgical treatment (n=21) (%)Acute Renal Failure 1 24.76Stroke 1 4.76CoNCLusioNAfter reviewing the results and comparing them to the International Registry of Acute Aortic Dissections (IRAD), it is clear that the decisions and treatment of patients at Lehigh Valley Health Network is of a high quality and is on par with other major institutions. While there are still major risk factors and complications, i.e. hypertension, unstable angina, acute renal failure, and atrial fibrillation, the outcomes of patients presented to this institution fared well. resuLts iN figures60%50%40%30%20%10%0%35%30%25%20%15%10%5%0%PercentPercentSurgicallyMedically IRAD IRAD LeHIGH VALLey HeALTH NeTWORk LeHIGH VALLey HeALTH NeTWORkMedicallySurgicallyType A Aortic Dissection Mortality RateType B Aortic Dissection Mortality RateType A in ArchType A DissectionType A Dissection 2Table 3. In-hospital complications in patients with type B dissectionComplications No. Incidence (n=119) (%)Acute Renal Failure 36 30.25Stroke 9 7.56Table 4.  30 day survivalVariable Total %Type A Dissection 62 71.26Surgical 50 75.75Medical 11 52.38Type B Dissection 108 90.75Manage TypeManage Type

Treatment of Acute Aortic Dissection at a Community Hospital: A 10 Year Review of Outcomes.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1027&context=surgery

Treatment of Acute Aortic Dissection at a Community Hospital: A 10 Year Review of Outcomes.

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