Patient-Centered Care Validation at NCH’s Monthly Cardiac Cath Conference

Cardiologists shared two very difficult clinical situations of patients presenting with life-threatening conditions, both literally having miraculous outcomes although with ups-and-downs during the “saves.”  Patients’ privacy is protected below due to the Health Insurance Portability and Accountability Act (HIPAA).

Dr. Ariel De La Rosa presented the story of an octogenarian who had crushing chest pain and was rushed to the Baker Hospital early on a weekend afternoon.  As part of NCH’s standardized and very successful eighteen-year-old Save-A-Heart program, the patient was quickly triaged in the Emergency Department and quickly taken to the Cardiac Cath lab.  Of note, the patient previously had cardiac surgery, which caused changes in the anatomy of the coronary arteries, making subsequent procedures much more difficult.  Then came a known and life-threatening complication.  One of the bypass grafts burst, allowing blood into the sack around the heart.

With smart and swift thinking, Dr. De La Rosa stopped the leak temporarily.  Preparing to drain the blood from around the heart, he very wisely held tight because the patient was hemodynamically stable.  An urgent ECHO cardiogram was performed confirming the diagnosis.  Cardiac surgeon Dr. Brian Solomon rushed in to assist. The family was consulted, and all agreed the elderly patient was a very high risk for another open-heart surgery.  Neuro-interventionist Dr. Mazen AbuAwad was then consulted, thinking that perhaps he could place a coil across the leaking coronary artery to permanently stop the leak.  This technique is similar to stopping a brain hemorrhage.  After further very tense moments, a coil was inserted, the bleeding stopped, and the patient recovered—all on a weekend afternoon.  Additional neuro-interventionists are joining our team shortly.

A middle-aged patient was transferred from a nearby hospital early one morning with crushing chest pain.  The patient had previous open heart surgery, which again makes treatment difficult the second time around.  The referring cardiologist tried to stop the heart attack during an emergent cardiac cath and realized cardiac surgery might be needed.  He called NCH cardiac surgeon Dr. Stephen D’Orazio, employed an external assist device, and sped the patient to the NCH Baker Hospital.  Upon receiving the pateint, Dr. D’Orazio collaborated with NCH interventional cardiologist Dr. Adam Frank, who assessed the patient, now stable and pain free due to the external assist device.  Again, cardiac surgery would be very high risk.  Thus, Dr. Frank worked cautiously, making his way to the blockage, all the time reassuring the patient who was awake, alert, and knowledgeable that treatment was going well.  Then came success—flow to the heart resumed, the external device removed, and the patient recovered.  Cardiac surgeon Dr. D’Orazio said this case was a first in his career—receiving a grateful patient letter from a patient he didn’t operate on.  Avoiding open heart surgery, as in these two patients with great outcomes, is a true credit to healthcare professionals working collaboratively, focused on patient-centered care.

AUTHOR:
Allen Weiss, M.D.
President and CEO