Bayhealth provides life-saving cardiac care close to home

March 1, 2014

yle="margin: 0px; text-indent: 12px; font-size: 10px; font-family: Times;">Many people in central and lower Delaware are unaware of the excellent program in adult cardiac surgery that is available at Bayhealth. “One of the things I’ve been most pleased with is that we have been able to provide access to life-saving care within our region,” said Dr. John Mannion, who developed the program at Bayhealth with Dr. Paul Fedalen 10 years ago. 

Patients really appreciate the care they have received. This is proven by the wonderful patient satisfaction scores received by our program and staff. “We continue to work on creating awareness of our program,” Mannion said.

“Before the establishment of our program in 2004, people who needed heart surgery had to travel to major medical centers such as Johns Hopkins in Baltimore, the Hospital of the University of Pennsylvania, or Peninsula Regional Medical Center in Salisbury. This distance limited access to heart surgery for residents of Kent and Sussex counties. Some patients have no trouble traveling that far, but many do. Occasionally, our local patients get lost in follow up or have difficulty returning to their primary care provider,” continued Mannion, who has since moved into an administrative role at Bayhealth.

Dr. Gary Szydlowski, Bayhealth’s new chief of cardiovascular and thoracic surgery, defined the three kinds of surgery performed at Bayhealth: Thoracic surgery involves anything in the chest including, but not limited to, the lungs, the lining around the lungs, major arteries and cancer anywhere in the chest. Vascular surgery includes clearing the arteries in the neck (for those at risk for stroke), creating access for dialysis, performing bypass surgery on legs and repairing an aneurysm in the abdomen, whether by open surgery or the new stenting procedures. Cardiac surgery involves any procedure on the heart, including coronary bypass, valve repair or replacement, procedures to correct abnormal heart rhythms, and operations on the aorta.

Szydlowski, who trained at Jefferson and then went to a large teaching hospital in Pittsburgh, came to Bayhealth from Lehigh Valley Medical Center which is described by Mannion as “one of the busier medical centers for heart surgery in the country and now a leading cardiac center.” Szydlowski is pleased with the quality and scope of Bayhealth’s program. “We do 98 percent of what those fields (cardiac, vascular and thoracic) include,” he said. “Occasionally, we send patients out to other institutions, given that some operations and illnesses can be better served at a larger institution. But in spite of the fact that ours is a smaller program, we have excellent results in all three specialties. As our volumes grow, we expect to have even better results. ”

Mannion added, “It is of no value to have heart surgery at a non-academic center if the results are not good. Results at Bayhealth really are quite excellent. We have been mentioned as one of the top 100 hospitals in the entire nation for our clinical results on mortality — the percentage of patients who survive. That’s a very good success rate. We’ve achieved that in two straight years. Previous to that, we had a five-star rating for valve surgery. So, over the course of 10 years, our patients, fortunately, (not meaning to brag) have had access to very superior outcomes when it comes to the most important reporting statistic — patient benefit from surgery. We are very pleased with that.”

Another advantage of a good local program with advances in cardiology, Mannion said, is that “many patients having a heart attack have to go to the closest hospital and be treated with stents and dilation. It’s always safest to have stent and angioplasty programs in a hospital that has heart surgery available so that heart surgery and other treatments can go hand in hand.”

Another unique aspect of our program, Mannion said, is that Bayhealth has a formal affiliation with the Hospital of the University of Pennsylvania, “so when we do have a complicated situation, or have a person in need of new technology we do not have available, we have quick access to the University of Pennsylvania Health System, which ranks among the best in the world for cardiac surgery. Six or seven programs in the Philadelphia area have cardiac affiliations with the University of Pennsylvania. That connection has improved the care delivered here because the new ideas and services that we develop jointly are also easily transferable.

“For example, we have developed a minimally invasive approach to treating thoracic and abdominal aneurysms so a patient does not need a large incision; rather, the condition can be effectively cured with a minimally invasive approach.

“Patients are usually in the hospital for just two or three days. Dr. Daniel Marelli is the surgeon doing these minimally invasive vascular repairs,” Mannion said.

“I am so happy with the connection with Penn! It provides us the latest information on best practices. We have a weekly meeting with Penn’s surgeons via the Internet, with constant discussion of approaches and outcomes. For me, it feels almost like I’m really a part of Penn’s faculty. It’s close to actually being there.

“The progress in technology has made operating in remote areas from academic medical centers much safer. It has made it possible for advances to be distributed faster at a local level,” Mannion said.

“Another aspect of our program that’s unique is our thoracic surgeon who does robotic lobectomy (removing a section of the lung). That surgeon is Dr. Paul Fedalen who went into private practice for a few years, expanding into thoracic and vascular surgery, before rejoining the group in Dover about two years ago. This is a great example of how Bayhealth services such as cardiac and oncology partner to provide expert care for patients in our region.

“There are very few surgeons in Philadelphia and I don’t think any others in Delaware who are able use a robot with such good results and such tiny incisions.”

Mannion also had high praise for Szydlowski, who joined the group last fall. “Dr. Szydlowski has vast experience and we anticipate some new programs may be able to be developed at Bayhealth using techniques he has already established at Lehigh Valley.”

Szydlowski said the group is beginning to investigate robotic heart surgery. “We’re evaluating this option and obtaining appropriate training. This robotic procedure would be on highly selected and limited cases. 

They are also investigating a new aortic valve replacement procedure, without the need for opening the sternum. Called TAVR, for “transcatheter aortic valve replacement,” the procedure can be done through a catheter in the groin or a small incision in the left side of the chest, Szydlowski said. He stressed, “The FDA has approved the procedure and the device; however, it is only being done in a limited number of centers. We’re investigating the possibility of doing TAVR here. There are certain requirements that have to be met first, so we are beginning to evaluate this program.”

Another procedure being done in limited, highly specialized centers is the use of a heart-lung machine called ECMO (Extracorporeal Membrane Oxygenation) to treat pneumonia.  This procedure uses a machine to take over the work of the lungs and sometimes the heart. “ECMO can be done here in an emergency,” Szydlowski said. “We are looking into expanding the program.”

He continued, “We are committed to keeping pace with more advanced techniques to see how they fit into this hospital and community; all within the setting of government regulations and requirements.”

Approximately 200 heart surgeries a year are performed at Bayhealth, Mannion said. “We are also very pleased to have a unique post-operative recovery, called One-Stop ICU. When a patient has cardiac surgery at Bayhealth, he or she stays in the same ICU bed until discharge. That is not possible at most other centers, but we designed our ICU that way because we think that this model enhances the results in moderate-size programs.

“Patients often have the same nurses during their stay and most patients have been very pleased with this model. Our approach has always been well received by patients and our satisfaction scores support this,” Mannion said.

“The greatest advantage is the concentration of expertise among our professional nursing staff. That has proved invaluable over the years. It would be the preferred method for every hospital if they could do it, but many can’t. It’s one of the unique characteristics of our program.”

Szydlowski added, “The nurses in the CVSICU are specifically trained for heart and thoracic care. Bayhealth has an excellent hospital system providing the framework to provide such advanced medical care. From capital improvements, equipment, operating room staff and physicians, the hospital is doing an excellent job.”

Mannion, who got his medical training at Cornell and the University of Pennsylvania, has been practicing since 1987 in cardiac surgery. He summed up the state of the cardiac surgery program: “We are very pleased with the first 10 years at Bayhealth. Results have been superior, and we are introducing new techniques and using them sometimes even before other medical centers, such as robotic lobectomies.

“Our greatest satisfaction comes from knowing that the people in the middle and lower section of Delaware have access to expert care, and that we have been able to save lives by providing a good quality, local program close to home.”

The program is centered in Dover. If a patient in the lower portion of Kent County or northern Sussex County is having a heart attack, frequently he or she will go to Milford Memorial Hospital and be evaluated. If anything at all needs to be done, we send the patient quickly to Bayhealth at Kent.

“We are pleased, and even more excited, about developments that are taking place now and will continue to take place in the future.”

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