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 2017 ​         FY 2018

Services Admissions
Bed
days
 Admissions Bed days​
 
​Cardiology 6,487 ​18,683

6,670​ 18,520​
​Cardiothoracic surgery 968 ​7,536
895​ 6,767​
 

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
  • Valvular disorders


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 over 300 transcatheter aortic valve implantations (TAVI). This cardiac procedure is designed to enable replacement of a diseased aortic valve without open heart surgery or surgical removal of the native valve. Thus, reducing risk of complications related to surgical procedures and reducing hospital length of stay. Epworth has increased its lead role among Australia’s private hospitals performing this procedure. 
  • 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.
    • The 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 surgeons are leaders in the Ross procedure, having performed the operation hundreds of times. 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

Activity

 

Epworth performs more than 700 cardiac surgery procedures per year. Procedures performed in cardiac surgery at Epworth from 2011-2017 are highlighted below in their respective groups:




Our performance-cardiac surgery


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:



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


To measure our performance, our cardiac surgery results are compared with other hospitals who participate in the Australia and New Zealand Society Cardiac and Thoracic Surgeons (ANZSCTS). Performance is measured by evaluating the risk associated with cardiac surgery including mortality, return to theatre for bleeding, deep sternal wound infection, stroke, readmission to hospital etc. Keeping in mind all surgery involves a small degree of risk, Epworth’s results compare favourably with all other hospitals. Current data indicates a low mortality rate of two percent, lower than average return to theatre for bleeding and stroke, no deep sternal wound infections and lower rate of readmission to hospital.


Other key performance measures are ventilation hours, intensive care stay and hospital length of stay.



Mortality rates following cardi​ac surgery ​


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


Other key performance measures – 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 ventilation times, ICU hours and length of stay in hospital has been associated with increased recovery following cardiac surgery. 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. Epworth’s average number of hours a patient is on a respiratory ventilator and length of stay in hospital following cardiac surgery is less than other cardiac surgery hospitals.


Current figures show ventilation hours for all cardiac surgery at Epworth average 11.2 hours compared to all other hospitals with an average ventilation time of 24.10 hours. Similarly, Epworth’s average length of stay for all cardiac surgery is 11.59 days compared to all other hospitals at an average of 13.50 days.

 


Our Performance – Cardiology

Epworth performs more than 800 PCI (percutaneous coronary intervention/angioplasty and stent) cases at the Richmond, Eastern and Geelong campuses 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.


The main performance measure that is used to monitor the performance of the care of PCI patients, is mortality within 30 days. This 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 also a recognised performance measure linked with adverse short and long-term outcomes, including increased mortality. Epworth's patient mortality rate following PCI (stent procedures) was 0.63% in 2017. This compares favourably with the Victorian benchmark of 1.89%. 


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. 


Image: Graph depicting Epworth's patient mortality rate


Cardiac Rehabilitation


Current evidence suggests rehabilitation benefits all cardiac patients by reducing readmission rates, mortality and enhancing recovery. Following discharge from a cardiac procedure, Epworth provides both inpatient and outpatient support services.


Since instituting the outpatient cardiac rehabilitation program in 1993, Epworth Heartsmart program has enrolled more than 7,000 cardiac patients following their discharge in its widely recognised HeartSmart Cardiac Rehabilitation Program. HeartSmart is designed to benefit and support patients regain full functionality following a cardiac episode. As outpatients, people are offered the choice of 4 separate session times each week with 3 of the programs spanning a 6-week period, a program strongly recommended for people post-cardiac surgery, while a 3 week ‘Fast Track program’ is specifically designed for Angioplasty and Stent patients. Well recognised as a beneficial program, the costs of attending HeartSmart are fully covered by most Private Health Funds.




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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