Department of Cardiothoracic
Surgery
St. George’s Healthcare NHS Trust
St. George’s University of London
General information - Personnel
Consultant cardiothoracic surgeons
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•
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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
2000
1820
1800
Number of cardiac surgery cases
1600
1400
1320
1270
1200
1040
1000
780
800
711
640
600
400
200
0
St. Thomas'
King's
SGH
Imperial (RBH
+ Harefield)
St. Mary's
Hammersmith
Barts &
London Chest
2012
2011
4
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
All cases
8
8.0
7
7.0
6
6.0
5
5.0
 3.4%
4.0
3
3.0
2
2.0
1
1.0
0
0.0
Results & volume – surgeon specific
2009-2012
Surgeon
• VC
• MJ
• RK
• JN
• MS
• JS
no cases
824
933
425
139
701
475
mortality (%)
2.31
3.23
3.53
1.87
2.53
2.53
Areas of expertise
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•
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Coronary artery bypass graft surgery, n=450-500
50% of volume of work
Beating heart (20%)
Mini-bypass
Mid-cab (minimal invasive)
2.0
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
CABG mortality
9.0
9.0
8.0
8.0
7.0
7.0
6.0
6.0
5.0
5.0
4.0
4.0
3.0
3.0
1.9%

2.0
1.0
1.0
0.0
0.0
Mitral valve surgery
• Mitral cases=80-140
• VC / MS
• Minimally invasive
mitral surgery
MVR
20.0
20.0
18.0
18.0
16.0
16.0
14.0
14.0
12.0
12.0
10.0
10.0
8.0
8.0
6.0
6.0
4.2%
4.0
4.0
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
0.0
1994
0.0
1993
2.0
1992
2.0
Aortic valve surgery
• Standard
• Minimally invasive aortic
valve replacement
(largest UK series and
program)
• 1 of 4 European training
centres
• TAVI
2012
2.0
2011
3.0
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
AVR
10.0
10.0
9.0
9.0
8.0
8.0
7.0
7.0
6.0
6.0
5.0
5.0
4.0
4.0

2.7%
3.0
2.0
1.0
1.0
0.0
0.0
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
NCBC – Activity, Throughput & Workload – 2010/11
Adult Major Cardiac Cases per Open/Funded Adult Cardiac Theatre, 2010/11
700
Cases per Theatre
598
517
500
23
346
598
234
499
445
404
400
384
382
381
379
361
356
346
340
331
328
325
320
309
303
300
Median
295
280
258
234
200
100
Lothian
Leicester
Oxford
Brom & Hare
Barts & London
Brighton
Basildon
North Staffs
Newcastle
Belfast
Nottingham
Blackpool
Imperial
Hull
Glasgow
Swansea
Liverpool
Sheffield
Bristol
South Tees
St George's
Papworth
0
Southampton
Adult Major Cardiac Cases per Adult Cardiac Theatre
600
Data Points
Median
Range - High
Range - Low
22
NCBC – Activity, Throughput & Workload – 2010/11
Adult Major Cardiac Cases per Adult Cardiac Surgeon Theatre (wte) & per Open/Funded Adult
Cardiac Theatre, 2010/11
800
Median
700
Major Cases per Theatre wte
Less scope
for increased
productivity
Imperial
Leicester
600
Southampton
42 week year
10 Major Cardiac
Cases
per week
500
St George's
Swansea
Bristol
South Tees
Oxford
400
Lothian
Brom & Hare
Barts & London
Basildon
North Staffs
300
Brighton
Hull
Blackpool
Glasgow
Newcastle
Sheffield
Nottingham
200
More scope
for increased
productivity
Median
Papworth
1 Major Cardiac
Case per session
10 sessions per
week
& 50 weeks p.a.
100
100
200
300
400
500
Major Cases per Open Adult Cardiac Theatre
600
700
23
NCBC – Clinical Management – 2010/11
Cardiac Surgery – CABG 1st – Non-elective Average Length of Stay, 2010/11
16.0
Source: Reference Costs – HRG4 & Supplementary Data Collection
CABG
14.5
Data Points
Median
Range - High
Range - Low
14.0
12.6
10.4
9.9
10.0
Median
9.6
9.0
8.8
6.2D
SGH 2012
8.6
7.9
8.0
7.8
7.5
7.4
7.4
7.3
7.1
6.8
6.7
6.7
5.8
6.0
5.2
5.1
4.5
4.3
4.0
3.4
3.4
2.0
North Staffs CTS
Southampton CS
Barts & London CTS
Imperial CTS
Basildon CTS
Blackpool CS
Blackpool CTS
Leicester CS
South Tees CTS
Sheffield CTS
Oxford CTS
Oxford CS
Papworth CS
St George's CTS
Newcastle CTS
Liverpool CTS
Imperial CS
Brom & Hare CS
Bristol CS
Lothian CS
Nottingham CS
Liverpool CS
Brighton CTS
Swansea CS
0.0
Glasgow CS
Average Length of Stay (days)
12.0
25
7.4
14.5
3.4
24
NCBC – Clinical Management – 2010/11
Cardiac Surgery – Single Valve– Elective Average Length of Stay, 2010/11
14.0
Source: Reference Costs – HRG4 & Supplementary Data Collection
Valve Surgery
Data Points
Median
Range - High
Range - Low
12.4
12.0
11.1 11.0 10.9
10.5 10.4
24
7.5
12.4
1.0
8.7
8.5
8.3
8.2
8.1
8.0
8.0
7.0
7.0
7.0
6.9
6.1d SGH
2012
Median
6.7
6.0
6.0
5.9
4.5
3.9
4.0
3.5
3.4
2.0
1.0
Imperial CS
Southampton CS
North Staffs CTS
Brighton CTS
Barts & London CTS
Oxford CS
Basildon CTS
Sheffield CTS
Blackpool CTS
Oxford CTS
Blackpool CS
St George's CTS
Papworth CS
South Tees CTS
Newcastle CTS
Brom & Hare CS
Leicester CS
Imperial CTS
Bristol CS
Nottingham CS
Liverpool CS
Lothian CS
Glasgow CS
0.0
Swansea CS
Average Length of Stay (days)
10.0
25
Quality of care
Matrices within Trust
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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
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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
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2012 / 2013. Royal College of Surgeons. Research fellowship. £56.145
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2011 /2013. Medtronic. Incidence of Cerebral Ischemia following Transcatheter
Aortic Valve Implantation compared to Surgical Aortic Valve Replacement. £96,000
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2010 / 2014. British Heart Foundation Programme Grant RG/09/004. Stem cells and
arteriosclerosis: from differentiation to experimental therapy. £1,124,537 *
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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
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2008 / 2009. British Heart Foundation Junior Research Fellowship. Anticoagulation following
tissue aortic valve replacement. £118,730
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2008 / 2009. St George’s Charitable Foundation, project grant: The role of inflammation and
structural remodelling in atrial fibrillation following cardiac surgery. £23,520
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2009 / 2011. Heart Research UK. Role of epicardial adipose tissue in coronary artery
disease. £82,979
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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
Number of scientific abstracts presented
10
9
8
7
6
5
4
3
2
1
0
SGH
Imperial
Liverpool
St. Thomas
Society for Cardiothoracic Surgery of GB & Ireland,
Annual Meeting 2012, Manchester
SCTS Annual Meeting 2012, Manchester
Number of scientific abstracts presented
12
10
8
6
4
2
0
SGH
Imperial
Birmingham
Liverpool
Leeds
Future aims
Increase volume
• 2012 =1000 cardiac cases
• Increase income
2013 > 1200 cases
Operational
• Theatre, CTICU, wards under different directorate –
amalgamate?
• Need 4th theatre
• Aortic rota
• Expansion of minimally invasive program
• Commissioning for training in CT surgery