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 = 20ward 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 specific 2009-2012 Surgeonno casesmortality (%) VC8242.31 MJ9333.23 RK4253.53 JN1391.87 MS7012.53 JS4752.53

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 3 rd 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. 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

21. National Cardiac Benchmarking Collaborative NCBC

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

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

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

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

26. Quality of care Matrices 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