Mr Pankaj Kumar MA FRCSMr Pankaj Kumar, MA, FRCS.Consultant Cardiothoracic Surgeon .

Structural Heart DiseaseStructural Heart DiseaseAll surgical casesAll surgical casesCABGAortic Valve DiseaseMitral Valve DiseaseMitral Valve DiseaseAortic SurgeryConcomitant AF SurgeryTAVITAVI

Format for PresentationFormat for PresentationUHW CardiffUHW, CardiffABM, SwanseaLHLC, Liverpool.

Audit groups leadsData – PATS, CCAD, SCTS.Unit Specific with UK comparatorUnit Specific with UK comparator

○ (CCAD/Blue Book)

ABM ABM UHW UHW LH&CH LH&CH UK UK

PROCEDURE N Crude Mortality

N Crude Mortality

N Crude Mortality

N Crude MortaliMortality

(%)Mortality

(%)Mortality

(%)Mortality (%

CABG – isol 1st time 324 1.9% (6) 353 0.3% (1) 206 2.4%(5) 17,512 1.5%

Aortic Valve isol 1st 71 1 4% (1) 57 0% 80 3 8% (3) 4 157 1 7%Aortic Valve – isol. 1st

time71 1.4% (1) 57 0% 80 3.8% (3) 4,157 1.7%

CABG +/- Redo +/-Other

29 6.8% (2) 18 5.5%(1) 0 0%Other

AVR + CABG +/-AF/Other_

120 5.8% (7) 105 0% 59 4.8% (3)

MVS i l +/ 26 11 5% (3) 50 8 0% (4) 43 0% 6 11%MVS – isol. +/-CABG +/- AF/Other

26 11.5% (3) 50 8.0% (4) 43 0% 6-11%

Multiple Valves +/-CABG +/ AF/Other

57 10.5% (6) 58 1.7%(1) 22 4.5% (1) 11-24%CABG +/- AF/Other 24%

TV Repair +/- CABG AF/Other

1 0% 2 0% 3 0%

A i ll 34 26 5% (9) 40 7 5% (3) 35 5 7% (2) 12 9%Aortic surgery - all 34 26.5% (9) 40 7.5% (3) 35 5.7% (2) 12.9%

Other Cardiac 24 4.1% (1) 13 0% 0 0%

Total 686 5% (35)

696 1.4% (10)

447 3.4% (15)

34,359 3%

Cardiac Surgery and Risk

Mean Age for All CasesMean Age for All Cases

Mean Age 5 yr trendMean Age – 5 yr trend

% of Octogenarians% of Octogenarians

% of Octogenarians 5 yr trend % of Octogenarians – 5 yr trend

Total Activity Elective vs UrgentTotal Activity – Elective vs Urgent

Isolated 1st CABG % of All ActivityIsolated 1st CABG - % of All Activity

1st time Isolated CABG 5 yr trend1st time Isolated CABG – 5 yr trend

Isolated 1st CABG Operative PriorityIsolated 1st CABG –Operative Priority

Isolated 1st CABG Risk Profile - AgeIsolated 1 CABG Risk Profile Age

Isolated 1st CABG Co-morbidity - DMIsolated 1 CABG Co morbidity DM

Isolated 1st CABG – Co-morbidity - DM Isolated 1 CABG Co morbidity DM

Isolated 1st CABG Co-morbidity – BMI>30

Co morbidity con’t LV function Co-morbidity con t - LV function

Trends in EF 1st time Isolated CABG

Isolated CABG - Number of grafts used

Isolated CABG - LIMA usageg

Isolated CABG Arterial ConduitsIsolated CABG – Arterial Conduits

Isolated CABG - Operative Strategy

Isolated CABG–MortalityIsolated CABG Mortality

Isolated CABG OutcomesIsolated CABG - OutcomesMCC UHW LHCH N ti lMCC UHW LHCH National

ITU/HDU St 48 h

2.2% 6.2% Median-1 A 2Stay >48 hrs Average -2

Re-op for bleeding

1.2% 2.6% 2.9% 2.7%

New CVVHF 0.6% 0.6% 3.4% 2.1%

New Stroke 0.6% 0.3% 1.0% 0.9%

In hospital 23.8% 25.0% 31.1%stay <6 days

Infection rate 0% 0% 1.0%

Valve Procedures % of Total ActivityValve Procedures – % of Total Activity

A ti V l l DiAortic Valvular Disease

Aortic Valve Procedure % of Total ActivityAortic Valve Procedure – % of Total Activity

Trend in mean age for all Aortic Valve Procedures

Trend in mean age for all AV Procedures

AVR by categoryAVR by category