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
1270
780
1040
1820
640711
1320
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St. Thomas' King's SGH Imperial (RBH+ Harefield)
St. Mary's Hammersmith Barts &London Chest
Num
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ardi
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ases
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
22
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517499
445
404384 382 381 379
361 356 346 340 331 328 325 320 309 303 295280
258234
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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
23
Barts & London
BasildonBlackpool
Brighton
Bristol
Brom & Hare
Glasgow
Hull
Imperial
Leicester
Lothian
NewcastleNorth Staffs
Nottingham
Oxford
Papworth
Sheffield
South Tees
Southampton
St George'sSwansea
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Maj
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ases
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Major Cases per Open Adult Cardiac Theatre
1 Major Cardiac Case per session10 sessions per
week& 50 weeks p.a.
42 week year10 Major Cardiac
Casesper week
Median
Median
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
24
14.5
12.6
10.49.9
9.69.0 8.8 8.6
7.9 7.87.5 7.4 7.4 7.3 7.1
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Aver
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Leng
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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
25
12.4
11.1 11.0 10.910.5 10.4
8.7 8.5 8.3 8.2 8.1 8.0
7.0 7.0 7.0 6.96.7
6.0 5.9
4.5
3.93.5 3.4
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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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SGH Imperial Liverpool St. Thomas
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Society for Cardiothoracic Surgery of GB & Ireland, Annual Meeting 2012, Manchester
SCTS Annual Meeting 2012, Manchester
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SGH Imperial Birmingham Liverpool Leeds
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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