Department of Cardiothoracic Surgery

1. Department of Cardiothoracic Surgery St. George’s Healthcare NHS Trust St. George’s University of London

2. General information - Personnel Consultant 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

3. General information • 2.5 wards, beds = 54 • CT ICU beds = 13 • Theatres = 3 (previously 4) Number of cases performed / annum • Cardiac = 1000 • Thoracic = 900

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

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

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10. 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

11. 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)

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13. Mitral valve surgery • Mitral cases=80-140 • VC / MS • Minimally invasive mitral surgery

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15. Aortic valve surgery • Standard • Minimally invasive aortic valve replacement (largest UK series and program) • 1 of 4 European training centres • TAVI

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17. Surgery of aorta • Large volume aortic surgery • 3rd largest in UK • Association with vascular surgery

18. Aortic surgery Non-emergency aortic surgery causes significant morbidity and mortality 8-12% in 978 procedures

19. (MJ)

20. STS database • 13,358 ARR • 741 centres Aortic surgery feedback to CT Society High volume experience and close follow-up can reduce complication rate and improve outcomes

21. National Cardiac Benchmarking Collaborative NCBC

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

23. NCBC – Activity, Throughput & Workload – 2010/11 Adult Major Cardiac Cases per Adult Cardiac Surgeon Theatre (wte) & per Open/Funded Adult Cardiac Theatre, 2010/11 Median Less scope for increased productivity 42 week year 10 Major Cardiac Cases per week Median 1 Major Cardiac Case per session 10 sessions per week & 50 weeks p.a. More scope for increased productivity

24. NCBC – Clinical Management – 2010/11 Cardiac Surgery – CABG 1st – Non-elective Average Length of Stay, 2010/11 Source: Reference Costs – HRG4 & Supplementary Data Collection Median 6.2D SGH 2012

25. NCBC – Clinical Management – 2010/11 Cardiac Surgery – Single Valve– Elective Average Length of Stay, 2010/11 Source: Reference Costs – HRG4 & Supplementary Data Collection 6.1d SGH 2012 Median

26. 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

28. Research Training and Education

29. 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

30. Training & education - Recognition • GMC survey 2012 – highest rank in all domains • Trainee survey at London Deanery – highest rank • Issue of EWTD – solved!

31. Courses & conferences • Valve technology symposium • Marfan association • Minimally invasive aortic valve surgery • CALS • Echo

32. 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

33. Research fellows & collaboration • 6 PhD, 9 MD (Res) awarded • 6 others are currently studying Collaboration • BHF centre of excellence, King’s College • University College

34. 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

35. European Association for Cardiothoracic Surgery Annual Meeting 2012, Barcelona

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

37. 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