The Small CTH Surgery Unit Challenges, Aspiration and Survival

The Small CTH Surgery Unit Challenges, Aspiration and Survival

The Small CTH Surgery Unit Challenges, Aspiration and Survival Hussein El Shafei Consultant Cardio-thoracic surgeon North of Scotland Cardio-Thoracic Surgery Unit Aberdeen Royal Infirmary & Aberdeen University Hospitals

2 4 Cardiac Surgery in Scotland Glasgow Biggest: ht Tx, VADs Congenital : Edinburgh Smaller: TAVI

Aberdeen: Serves north of Scotland( 1.25 Million) Big issue now; Shortage of theatre staffing: frequent cancellation, depressed capacity and very long WTs. 2013-2016 Open hearts G= 3770 E= 2482 A=1404

5 The Small Unit Advantages & Disadvantages

-More simpliefied: admin., management, governance and finance Less overheads in management ? -Family like workforce Better communication Better continuity of care - Less distracting politics

No sub-specialization Volume outcome curve (in Th not Cardiac) Marginal Cost high Limited resource for advancing technology, e.g. robotic Family-like workforce

No Back up of staff absence..e.g. Theatre Staffing 6 Working in Big Hospital: Piezo-Electric Scalpel in Constrictive pericarditis

7 Small Unit Big Hospital Maxillo-Facial Tool For Constrictive Pericarditis Working in the Big Hospital: Plastic Surgery

9 Working in the big hospital: No re-wiring for many years 10

Less Invasive Mitral Valve Surgery in Aberdeen for 6 Years 11 Cor Knot in Most Valve Cases 12

Complex aortic surgery with help from Expert Colleagues.. Professor Aung Oo 13 Mentored by Colleagues In Kings College Hospital, Mr Max Bhagi

14 Rapid Deployment Perceval Sutureless Valve

More than 50,000 Implants 10 Year durability, No SVD Compression does not cause harm Double layer design, leaflets not fixed to annulus

Excellent haemodynamics and very low gradient Age criteria changing 15 Sutureless Valves 16

Sutureless Valves : Indications Rapid Deployment. Speed (Combined cases+CABG?) Minimally Invasive Surgery :Ministernotomy or RAT BUT Importantly BAIL OUT: -Redo - Endocarditis -Calcified Homografts

- Small calcified annulus( Low Gradient) 17 Cardiac Surgery in Scotland A National review is needed to identify the future demands, capacities Number of units: One Two Three and where? Vision for the future of the integrated services, the

changing workforce, atmosphere and the advancing technology 18

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