3 uncommon surgeries occur simultaneously at AGH
Patients suffering from potentially deadly heart condition survive
Pittsburgh Post-Gazette
At 3 p.m. March 7, Mark Iobst and a friend were finishing electrical work at an apartment he owns when he felt severe chest pain. In time, his friend drove him to Raleigh General Hospital in Beckley, W.Va., where he was diagnosed not with a heart attack but a type A aortic dissection.
Once diagnosed, Mr. Iobst, 63, of Beckley, a chaplain at the Beckley VA Medical Center, was flown by medical helicopter to Ruby Memorial Hospital in Morgantown then to Allegheny General Hospital on the North Side. He arrived there at 3:30 a.m. And that’s where things got interesting with a situation believed never to have occurred before at AGH and unlikely ever to happen again.
About the same time of Mr. Iobst’s arrival, a female patient was brought in from West Penn Hospital in unstable condition with a similar aortic dissection.
Then 15 minutes later, Tom Gilbert, 60, of Glen Dale, W.Va., who experienced a “lightning bolt of pain,” while helping his brother fix a light in his basement, arrived at 3:45 a.m. from Reynolds Hospital in West Virginia with an aortic dissection.
Three cases of an uncommon but potentially deadly condition had arrived within 15 minutes of each other, all requiring complex open-heart surgery with each person’s life on the line.
With advanced warning, Stephen Bailey, AGH division director of cardiac surgery and one of three surgeons called into action that night, summoned sufficient medical staff to the hospital, arranged for necessary blood products through the Central Blood Bank and assured that all other resources, including three open-heart operating rooms, were ready for what promised to be the busiest morning on record.
All three surgeries got underway within an hour of each other — from 5:09 a.m. to 6:15 a.m. — and continued simultaneously for six hours, with the surgeries ending at 12:25 p.m., 1:18 p.m. and 2:09 p.m.
George Magovern, system chairman for Allegheny Health Network’s department of thoracic and cardiovascular surgery, said the hospital performs about 40 type A aortic dissection surgeries each year, each one with its own complexities and lasting between four and 12 hours, depending upon location and level of damage from the aortic tear. “This,” he said, “was a big deal.”
Each medical team involved up to nine people, including nurses, anesthesiologists and other medical specialties, with each patient potentially requiring up to six pints of blood, platelets and fresh frozen plasma, he said.
During the surgery, the body and brain of each patient must be cooled dramatically to about 68 degrees to reduce the need for oxygen, allowing for 30 minutes of surgery without blood flow. Returning the body to normal temperature after the surgery also can lead to dangerous blood abnormalities.
One of the three surgeons, Robert Moraca, AGH director of thoracic and aortic arrhythmia surgery, said that one dissection surgery is like launching a Space Shuttle. “So it was like launching three Space Shuttles at the same time,” he said.
The third surgeon responding to the call that day was Walter McGregor, director of AGH’s Thoracic Surgery Residency Program.
Months later, all three patients have survived their medical ordeal and have done so without complications. Mr. Iobst and Mr. Gilbert returned to the hospital with family members Tuesday to describe their experiences and personally thank the surgeons who saved their lives, all before attending a Pirates game, gratis AGH.
“I’m very grateful to Dr. Moraca and the entire Allegheny General team — the doctors and nurses and everyone else — for my experience and how they saved my life,” said Mr. Gilbert, an insurance salesman.
When he experienced the pain in his chest he didn’t want to go to the hospital, but his wife, Beth, convinced him to go. He was diagnosed at Reynolds Memorial Hospital in Glen Dale with the dissection and was quickly flown by medical helicopter to AGH.
“There was no damage when I woke up 22 days later [due to an induced coma] with no pain,” he said. “My incision already had healed.”
As it turns out, AGH and UPMC Shadyside handle most of dissection surgeries throughout the TriState area and in just about equal numbers, with Shadyside performing 40 to 50 per year, said Forozan Navid, a cardiothoracic surgeon at UPMC Shadyside and Presbyterian. He said his team has a 90 percent survival rate; the worldwide survival rate is 70 to 75 percent.
The three layers of the aorta are like plywood, he said, and can begin shearing from the pumping force of blood from the heart. As blood gets under each layer, the damage expands along the blood vessel and the health risk grows, with resulting pain representing “the worst pain the person has ever experienced.” Once the outer layer ruptures, there’s little hope for survival.
“This is not a common entity,” Dr. Navid said, noting that AGH experienced “just pure coincidence to have three at one time.”
David Templeton: dtempleton@post-gazette.com or 412-263-1578.