Cardiac Sciences



Director: Associate Professor Ronald Dick
Deputy Directors: Mr Aubrey Almeida, Mr Peter Skillington


Services​

Over many years of treatment and research, Epworth has developed a comprehensive range of services from initial diagnosis to post-operative care and lifestyle advice resulting in world class treatment and best possible medical outcomes for all cardiac and circulatory system conditions.

The Cardiac Sciences Clinical Institute is committed to the care of patients with cardiac disease and provides the highest standards in investigation and management to ensure a speedy and effective recovery for patients..

 

Activity

 
 
​        FY 2014 ​        FY 2015 FY 2016

Services Admissions
Bed
days
Admissions Bed
days
 Admissions Bed days​
 
​Cardiology ​5,758 ​19,500 ​5,744 18,922 5,822​ 19,611​
​Cardiothoracic surgery ​889 ​8,060 ​875 ​7,642 920​ 7,942​
 

The numbers above include more than 1000 procedures for diagnosing and treating the abnormal electrical activities of the heart (includes pacemakers, defibrillators and ablation of pathways), and more than 700 procedures for treating blockages of coronary arteries.


 Conditions treated include:

 

  • Aneurysm
  • Angina
  • Atrial fibrillation
  • Cardiac arrest
  • Coronary artery spasm
  • Coronary heart disease
  • Deep vein thrombosis
  • Familial hypercholesterolaemia
  • Heart attack
  • Heart failure
  • High blood pressure
  • Palpitations.


Highlights

 

  • Longitudinal data covering more than 30 years, preceding national registry performance.
  • Epworth performs many specialist and complex procedures, attracting patients nationally and from overseas. 
  • Epworth has performed the highest number of procedures in Australia as part of an international trial to treat severe aortic stenosis using Medtronic’s Core Valve System. This cardiac procedure is designed to enable replacement of a diseased aortic valve without open heart surgery or surgical removal of the native valve. The trial is currently taking place in 12 Australian hospitals. Epworth has increased its lead role among Australia’s private hospitals performing this procedure with more than 200 of the 800 procedures performed in Australia taking place at Epworth Richmond. 
  • Robotic mitral valve surgery has been performed at Epworth Hospital since 2004. Epworth doctors have one of the largest experiences of this procedure in the world, having performed several hundred robotic mitral valve repairs. The procedure performed with the da Vinci Robotic system enables complex mitral valve operations to be performed via a small incision on the side of the chest. The advantages of this are less pain, less need for blood transfusion and shorter recovery times. Patients are able to return to full activity in around one third of the time compared to standard operations that require cutting the breast bone. It is preferable to repair a mitral valve if possible as repairs are more durable than tissue valve replacements and do not require anticoagulation medicine like mechanical valve replacements. The rate of success of mitral valve repair has been 99%, which is amongst the best in the world.
  • A new Siemens Artis Q hybrid biplane theatre, the first of its kind in Australia and New Zealand, makes Epworth Richmond the first private hospital in Victoria to offer open and endovascular capabilities for neurosurgery, cardiac and vascular procedures. The hybrid biplane theatre combines advanced, high-precision imaging technology with a fully equipped surgical suite, providing the surgeon with unique insights into anatomical details as well as physiological and functional information during surgery. The hybrid technology allows surgeons to perform minimally invasive procedures that result in safer, faster and more efficient treatment of patients. 
  • The Ross Procedure is a type of specialized aortic valve surgery where the patient's diseased aortic valve is replaced with his or her own pulmonary valve. Because it is their own tissue, the valve is not rejected. The pulmonary valve is then replaced with a donor pulmonary valve. Epworth specialist cardiothoracic surgeon Epworth is a leader in the Ross procedure, having performed it hundreds of times. His patients do not have to take medications such as the anti-coagulant medication Warfarin, which they would need to do if they received a mechanical valve replacement, and the valve lasts for up to 50 years.
  • Epworth has commenced using the Maze IV surgical technique (AtriCure) for the treatment of atrial fibrillation (AF) in cardiac patients. Australasia’s first Maze IV one-day training course was held at Epworth. In Australia, about 15 per cent of patients undergoing open heart surgery have a history of AF, but only 25 per cent of these patients undergo an ablative procedure for their AF. Ablation is the use of flexible tubes (catheters) inserted through a vein in the groin to correct structural problems in the heart. Recent advances in technology as well as a better understanding of AF have resulted in an increasing uptake of AF ablation procedures by cardiac surgeons.

Our performance—cardiac surgery

 

Epworth performs more than 700 cardiac surgery procedures per year.


 


For the purpose of monitoring and comparing information, cardiac surgery is classified into four separate groups: 

  1. Coronary artery bypass grafts (CABG) performed without any other simultaneous procedure, 
  2. Any valve procedure performed without any other simultaneous procedure (Valve), 
  3. A combination of a simultaneous coronary artery bypass AND any valve procedure (CABG and Valve), 
  4. ‘Other’ procedures include surgery of the Aorta and heart rhythm abnormalities, and any other procedure in combination with CABG, valve or both (CABG and valve).


Procedures performed in cardiac surgery at Epworth from 2011–2015 are highlighted below in their respective groups:

Image: Cardiac procedures performed at Epworth 2011-15

Coronary artery bypass grafts are the most common type of cardiac surgery performed on adults.

To measure our performance, our cardiac surgery results are compared with other hospitals that participate in the Australia and New Zealand Society Cardiac and Thoracic Surgeons​ (ANZSCTS).


All surgery involves a small degree of risk. One of the key performance measures used by ANZSCTS is mortality following cardiac surgery. Below are the most current available results for  Epworth and the comparative data from all contributing hospitals. Epworth’s results compare very favourably with the ANZSCTS data.


Mortality rates following cardi​ac surgery ​

Image: Graph indicating mortality rates following cardiac surgery
Highlight: mortality rates following cardiac surgery at Epworth are consistently and significantly lower than or similar to the national average. 


Intensive care and length of hospital stay following cardiac surgery


The initial management of patients following cardiac surgery occurs in the intensive care unit (ICU). On average, most patients can expect to stay two to four days in ICU before transfer to the cardiac ward for a further eight to twelve days. 


Less ICU hours and length of stay in hospital has been associated with increased recovery following cardiac surgery. The graphs below indicate Epworth has similar or lower ICU times and length of hospital stay compared with all contributing hospitals. 


The two graphs below show that the average number of hours a patient is on a respiratory ventilator and nursed in intensive care following cardiac surgery are less than other cardiac surgery centres. The implication of this is that Epworth patients have better surgical outcomes and require a shorter period of intensive care following a cardiac procedure.


Medical ventilation is needed when the patient’s own natural breathing is not sufficient to maintain life. While mechanical ventilation is often a life-saving intervention, it also carries the risk of potential complications. For this reason, a lower number of hours on a ventilator is a positive result. 


Hours in ICU following car​​diac procedures

Image: Graph depicting hours in ICU following cardiac procedures

Highlight: the number of hours in ICU following a cardiac procedure are consistently and significantly lower at Epworth than the national average.


Length of hosp​ital ​stay

Image: Graph depicting length of hospital stay
Highlight: Less ICU hours and length of stay in hospital has been associated with increased recovery following cardiac surgery. The length of hospital stay following a cardiac procedure is consistently and significantly lower at Epworth than the national average. 

​ 
 

Our Performance – Cardiology



Epworth performs more than 800 percutaneous coronary interventions (PCI) (angioplasty and stent) cases annually to treat coronary artery disease. To measure our performance, our cardiology treatment results are compared with other hospitals that participate in the Victorian Cardiac Outcomes Registry​ (VCOR) quality of care projects.


Two of the performance measures that are used to monitor the performance of the care of PCI patients are mortality < 30 days and major bleeding rates (see table below). The mortality rate varies according to the clinical presentation. Patients presenting with cardiogenic shock or out-of-hospital cardiac arrest had the highest mortality rate; these are the most unwell patients. At the other end of the spectrum, patients presenting with low-risk clinical presentations had a much lower in-hospital mortality rate. In-hospital major bleeding is a recognised performance measure linked with adverse short and long-term outcomes, including increased mortality.

Image: Graph depicting Epworth's patient mortality rate

Epworth's patient mortality rate following PCI (stent procedures) was 0.65% in 2014. This compares favourably against the statewide benchmark of 2.00%. 


For most elective PCI cases, length of hospital stay is expected to be one day, whereas PCI in patients with acute coronary syndromes is typically associated with multi-day hospital stay, usually related to the underlying condition rather than the actual procedure. 


Queries

If you have any queries regarding the data on this page, please email ClinicalProfile@epworth.org.au



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