Department of Cardiothoracic Surgery

St. George’s Healthcare NHS Trust

St. George’s University of London

General information - PersonnelConsultant cardiothoracic surgeons• Mr. V. Chandrasekaran• Professor Marjan Jahangiri• Mr. Ian Hunt• Mr. Robin Kanagasabay• Mr. Justin Nowell• Mr. Mazin Sarsam• Mr. John Smith• Miss Carol Tan

• Junior surgeons = 16• Theatre nurses = 20 ward nurses = 42• Perfusion scientists = 8

General information

• 2.5 wards, beds = 54

• CT ICU beds = 13

• Theatres = 3 (previously 4)

Number of cases performed / annum

• Cardiac = 1000

• Thoracic = 900

SGH, 1 of 3 hospitals in UK for completion, accuracy of data for past 5 yrs

UK National (22,000 cases / annum) NHS London - 2011

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St. Mary's Hammersmith Barts &London Chest

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Results & volume – surgeon specific2009-2012

Surgeon no cases mortality (%)

• VC 824 2.31

• MJ 933 3.23

• RK 425 3.53

• JN 139 1.87

• MS 701 2.53

• JS 475 2.53

Areas of expertise

• Coronary artery bypass graft surgery, n=450-500• 50% of volume of work• Beating heart (20%)• Mini-bypass• Mid-cab (minimal invasive)

Mitral valve surgery

• Mitral cases=80-140• VC / MS• Minimally invasive

mitral surgery

Aortic valve surgery

• Standard• Minimally invasive aortic

valve replacement (largest UK series and program)

• 1 of 4 European training centres

• TAVI

Surgery of aorta

• Large volume aortic surgery

• 3rd largest in UK

• Association with vascular surgery

Aortic surgery

Non-emergency aortic surgery causes significant morbidity and mortality

8-12% in 978 procedures

(MJ)

Aortic surgery feedback to CT Society

High volume experience and close follow-up can reduce complication rate and improve outcomes

STS database• 13,358 ARR• 741 centres

National Cardiac Benchmarking Collaborative

NCBC

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NCBC – Activity, Throughput & Workload – 2010/11Adult Major Cardiac Cases per Open/Funded Adult Cardiac Theatre, 2010/11

Median

Cases per Theatre Data Points 23Median 346Range - High 598Range - Low 234

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1 Major Cardiac Case per session10 sessions per

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42 week year10 Major Cardiac

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NCBC – Activity, Throughput & Workload – 2010/11Adult Major Cardiac Cases per Adult Cardiac Surgeon Theatre (wte) & per Open/Funded Adult

Cardiac Theatre, 2010/11

More scopefor increasedproductivity

Less scopefor increasedproductivity

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NCBC – Clinical Management – 2010/11Cardiac Surgery – CABG 1st – Non-elective Average Length of Stay, 2010/11

Median

CABGData Points 25Median 7.4Range - High 14.5Range - Low 3.4

Source: Reference Costs – HRG4 & Supplementary Data Collection

6.2DSGH 2012

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NCBC – Clinical Management – 2010/11Cardiac Surgery – Single Valve– Elective Average Length of Stay, 2010/11

Median

Valve SurgeryData Points 24Median 7.5Range - High 12.4Range - Low 1.0

Source: Reference Costs – HRG4 & Supplementary Data Collection

6.1d SGH 2012

Quality of careMatrices within Trust

• Personalised service• Discharge summaries 96%• VTE >90%• 18 week target – backlog is reduced by 90%,

completely within target as of 10 Nov 2012

In-patient service in London • Median time 38 days (24 - 51d)• SGH 2012 = 22 days

Research

Training and Education

Training & education

• Training in CT surgery is through national selection• 20-24 appointments / yr in UK• For the past 4 years, the top 3-4 candidates have been

from SGH• 2010- Appointment of academic clinical lecturer

National roles• London Deanery, Training program director – MJ• Chair, specialist training committee for CT surgery - MJ• Chair, intercollegiate specialty board (examining board)- JS

Training & education - Recognition

• GMC survey 2012 – highest rank in all domains

• Trainee survey at London Deanery – highest rank

• Issue of EWTD – solved!

Courses & conferences

• Valve technology symposium

• Marfan association

• Minimally invasive aortic valve surgery

• CALS

• Echo

Areas of research

• Diseases of aorta & aortic valve

• Genetics & associated aortopathies

• Trials comparing neurological complications in patients undergoing AVR compared to TAVI

• European trial SURTAVI – UK lead

• Quality of life in patients with prolonged ICU stay

Research fellows & collaboration

• 6 PhD, 9 MD (Res) awarded

• 6 others are currently studying

Collaboration

• BHF centre of excellence, King’s College

• University College

Research grants• 2012 / 2013. Royal College of Surgeons. Research fellowship. £56.145

• 2011 /2013. Medtronic. Incidence of Cerebral Ischemia following Transcatheter Aortic Valve Implantation compared to Surgical Aortic Valve Replacement. £96,000

• 2010 / 2014. British Heart Foundation Programme Grant RG/09/004. Stem cells and arteriosclerosis: from differentiation to experimental therapy. £1,124,537 *

• 2009 / 2010. Royal College of Surgeons of England Research Fellowship. The Role of Statins

and Proteomics in Prevention of Atrial Fibrillation Following Cardiac Surgery. £50,000

• 2008 / 2009. British Heart Foundation Junior Research Fellowship. Anticoagulation following tissue aortic valve replacement. £118,730

• 2008 / 2009. St George’s Charitable Foundation, project grant: The role of inflammation and structural remodelling in atrial fibrillation following cardiac surgery. £23,520

• 2009 / 2011. Heart Research UK. Role of epicardial adipose tissue in coronary artery disease. £82,979

• 2009 / 2010. Pierburg Foundation, donation to St. George’s Charitable Foundation. £55,591• 2009 / 2011. Medtronic. Antithrombotic therapy following valve replacement. £28,000

European Association for Cardiothoracic Surgery Annual Meeting 2012, Barcelona

EACTS Annual Meeting 2012, Barcelona

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Society for Cardiothoracic Surgery of GB & Ireland, Annual Meeting 2012, Manchester

SCTS Annual Meeting 2012, Manchester

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Future aims

Increase volume • 2012 =1000 cardiac cases 2013 > 1200 cases• Increase income

Operational• Theatre, CTICU, wards under different directorate –

amalgamate?• Need 4th theatre• Aortic rota• Expansion of minimally invasive program• Commissioning for training in CT surgery