Cardiothoracic Surgery

Cardiothoracic Surgery Programme

Cardiothoracic surgery consists of surgery on the heart and surrounding blood vessels (commonly referred to as “open heart surgery”) and surgery on the other structures that form the thorax, especially the lungs. More than 3500 adults undergo heart surgery in NZ each year, making cardiac surgery one of the commonest major surgical procedures. Although there are many different types of thoracic surgery the most common indication is for lung cancer, which is the leading cause of cancer deaths in NZ, however prompt surgical treatment can significantly improve patients prognosis.

All publically funded cardiac surgery and most thoracic surgery in NZ is conducted at specialist centres at 5 hospitals (Auckland City, Waikato, Wellington, Christchurch and Dunedin Hospital). The complex nature of the surgery involves surgeons, anaesthetists, Intensivists and specialist nurses working as a team to provide specialist care.

The Improving Outcomes after Cardiothoracic Surgery Network (IOACSNet) has recently been established within the Medical Research Institute of New Zealand (MRINZ) as a national clinical and translational research initiative involving leading clinicians and researchers involved in the management of patients undergoing cardiothoracic surgery. The primary aim of this programme is to undertake a series of integrated national and international multidisciplinary clinical research projects which will lead to better outcomes for patients undergoing this surgery in NZ.

Cardiac Surgery

The cardiac surgical programme has been launched with 5 key clinical trials;

Transfusion Requirements In Cardiac Surgery (TRICS III)

What is the most effective blood transfusion trigger to use in patients undergoing cardiac surgery?

Blood transfusion is very common during and after cardiac surgery however there is little evidence to guide clinicians as to when they should transfuse patients. TRICS III is a large international study conducted in 16 countries and coordinated from Canada that will provide high quality evidence to help clinicians decide when they should give patients a blood transfusion. All 5 NZ cardiac surgical centres are participating in this important study.

Left Atrial Appendage Occlusion Study (LAAOS III)

Does removal of the left atrial appendage at the time of cardiac surgery reduce the long term morbidity associated with atrial fibrillation?

Atrial fibrillation (AF) if the commonest heart arrhythmia and is associated with a greatly increased risk of stroke and other complications. The source of many of the blood clots that cause strokes is the Left atrial appendage (LAA), a small pouch attached to one of the heart chambers. LAAOS III is a large international study that will test if removal of the LAA during heart surgery reduces the long-term risk of stroke in patients with AF.

Fluid after Bypass (FAB)

Will a rationalised post-operative fluid regime improve patient outcomes and decrease resource use?

Intravenous fluid therapy is ubiquitous for patients following cardiac surgery. In many groups of patients there is an association between the volume of fluid given and adverse outcomes. Dr Rachael Parke is leading a NZ programme of research designed to determine if using a more protocolised approach to fluid therapy will improve patient outcomes and decrease ICU length of stay in these patients.

Corticosteroid Effects on inflammation, Long-term disability and Survival in patients Undergoing cardiac Surgery (CELSUS)

Is immunomodulation with high dose corticosteroids beneficial for younger patients undergoing cardiac surgery?

Steroids are often given to patients having cardiac surgery however two big recent trials have cast doubt on the benefits of using them in all patients. There is some evidence suggesting that they may be beneficial in younger patients, especially those who are at higher risk of complications. This large multi-national study will provide high quality evidence as to the benefit of steroid administration in this group of cardiac surgical patients.

IV Iron for Treatment of Anaemia before Cardiac Surgery (ITACS)

Can post-operative complications be reduced by treating anaemia with intravenous iron pre-operatively?

Anaemia is common in patients presenting for cardiac surgery and these patients have a high chance of requiring a blood transfusion. The ITACS study aims to determine if anaemic patients who are given supplemental intravenous iron a few weeks before surgery have better outcomes.

Thoracic Surgery

Lung cancer is a major health problem in New Zealand resulting in 1700 deaths each year and is the leading cause of all cancer deaths at around 19%. Survival is worse for the NZ population compared to other countries. For people with localised disease survival is greatly increased if the tumour is able to be surgically removed, and surgery is now the preferred treatment. Postoperative morbidity and complications are common, particularly in older patients, and can occur in up to 55% of cases. Enhanced Recovery Programs (ERP) use a multi-modal, multidisciplinary approach to perioperative care to reduce complications and promote faster recovery. ERPs involve a paradigm shift towards a high degree of inter-disciplinary teamwork in partnership with the patient and their family/whanau to ensure optimisation of individual function and outcomes throughout the treatment period. ERPs have been shown to be highly effective in other surgical populations but as yet there is little evidence of benefits in thoracic surgical patients.

The THOR study is being conducted by Dr Rachael Parke at Auckland City Hospital and aims to determine if an ERP will improve outcomes for patients undergoing thoracic surgery for lung cancer and if it is cost-effective compared to current practice.

Cardiothoracic Surgery

Cardiothoracic Surgery Programme

Cardiothoracic surgery consists of surgery on the heart and surrounding blood vessels (commonly referred to as “open heart surgery”) and surgery on the other structures that form the thorax, especially the lungs. More than 3500 adults undergo heart surgery in NZ each year, making cardiac surgery one of the commonest major surgical procedures. Although there are many different types of thoracic surgery the most common indication is for lung cancer, which is the leading cause of cancer deaths in NZ, however prompt surgical treatment can significantly improve patients prognosis.

All publically funded cardiac surgery and most thoracic surgery in NZ is conducted at specialist centres at 5 hospitals (Auckland City, Waikato, Wellington, Christchurch and Dunedin Hospital). The complex nature of the surgery involves surgeons, anaesthetists, Intensivists and specialist nurses working as a team to provide specialist care.

The Improving Outcomes after Cardiothoracic Surgery Network (IOACSNet) has recently been established within the Medical Research Institute of New Zealand (MRINZ) as a national clinical and translational research initiative involving leading clinicians and researchers involved in the management of patients undergoing cardiothoracic surgery. The primary aim of this programme is to undertake a series of integrated national and international multidisciplinary clinical research projects which will lead to better outcomes for patients undergoing this surgery in NZ.

Cardiac Surgery

The cardiac surgical programme has been launched with 5 key clinical trials;

Transfusion Requirements In Cardiac Surgery (TRICS III)

What is the most effective blood transfusion trigger to use in patients undergoing cardiac surgery?

Blood transfusion is very common during and after cardiac surgery however there is little evidence to guide clinicians as to when they should transfuse patients. TRICS III is a large international study conducted in 16 countries and coordinated from Canada that will provide high quality evidence to help clinicians decide when they should give patients a blood transfusion. All 5 NZ cardiac surgical centres are participating in this important study.

Left Atrial Appendage Occlusion Study (LAAOS III)

Does removal of the left atrial appendage at the time of cardiac surgery reduce the long term morbidity associated with atrial fibrillation?

Atrial fibrillation (AF) if the commonest heart arrhythmia and is associated with a greatly increased risk of stroke and other complications. The source of many of the blood clots that cause strokes is the Left atrial appendage (LAA), a small pouch attached to one of the heart chambers. LAAOS III is a large international study that will test if removal of the LAA during heart surgery reduces the long-term risk of stroke in patients with AF.

Fluid after Bypass (FAB)

Will a rationalised post-operative fluid regime improve patient outcomes and decrease resource use?

Intravenous fluid therapy is ubiquitous for patients following cardiac surgery. In many groups of patients there is an association between the volume of fluid given and adverse outcomes. Dr Rachael Parke is leading a NZ programme of research designed to determine if using a more protocolised approach to fluid therapy will improve patient outcomes and decrease ICU length of stay in these patients.

Corticosteroid Effects on inflammation, Long-term disability and Survival in patients Undergoing cardiac Surgery (CELSUS)

Is immunomodulation with high dose corticosteroids beneficial for younger patients undergoing cardiac surgery?

Steroids are often given to patients having cardiac surgery however two big recent trials have cast doubt on the benefits of using them in all patients. There is some evidence suggesting that they may be beneficial in younger patients, especially those who are at higher risk of complications. This large multi-national study will provide high quality evidence as to the benefit of steroid administration in this group of cardiac surgical patients.

IV Iron for Treatment of Anaemia before Cardiac Surgery (ITACS)

Can post-operative complications be reduced by treating anaemia with intravenous iron pre-operatively?

Anaemia is common in patients presenting for cardiac surgery and these patients have a high chance of requiring a blood transfusion. The ITACS study aims to determine if anaemic patients who are given supplemental intravenous iron a few weeks before surgery have better outcomes.

Thoracic Surgery

Lung cancer is a major health problem in New Zealand resulting in 1700 deaths each year and is the leading cause of all cancer deaths at around 19%. Survival is worse for the NZ population compared to other countries. For people with localised disease survival is greatly increased if the tumour is able to be surgically removed, and surgery is now the preferred treatment. Postoperative morbidity and complications are common, particularly in older patients, and can occur in up to 55% of cases. Enhanced Recovery Programs (ERP) use a multi-modal, multidisciplinary approach to perioperative care to reduce complications and promote faster recovery. ERPs involve a paradigm shift towards a high degree of inter-disciplinary teamwork in partnership with the patient and their family/whanau to ensure optimisation of individual function and outcomes throughout the treatment period. ERPs have been shown to be highly effective in other surgical populations but as yet there is little evidence of benefits in thoracic surgical patients.

The THOR study is being conducted by Dr Rachael Parke at Auckland City Hospital and aims to determine if an ERP will improve outcomes for patients undergoing thoracic surgery for lung cancer and if it is cost-effective compared to current practice.

Cardiothoracic Surgery