St. Paul’s Hospital, BC, Canada
Located on the Pacific coast of Canada, St. Paul’s Hospital is the major cardiac quaternary referral center for a catchment area that extends from the United States to the south and the arctic to the north, with a population of just under 5 million.
Associated with the University of British Columbia St. Paul’s has the only full service structural heart, adult congenital, VAD, transplant, and transcatheter heart valve programs in British Columbia.
St. Paul’s Hospital has a long history of developing first in human therapies, with a 15 year history of implanting transcatheter valves in animal models and decade since developing the first successful transarterial and transapical valve programs.
Research has led to over 200 journal and textbook publications on transcatheter valves. A major focus on training has led to physicians across North America and over 25 other countries, including excellent trainees from Australia and New Zealand, receiving formal transcatheter valve training in Vancouver.
Currently St. Paul’s has by far the largest transcatheter valve program in Canada and arguably has the broadest experience anywhere with a full range of transcatheter aortic, mitral, pulmonary and tricuspid repair, replacement, and valve-in-valve options.
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The Alfred Hospital, Melbourne, VIC
The Department of Cardiovascular Medicine/Heart Centre at The Alfred in Melbourne assesses and treats patients with all forms of adult cardiovascular disease. The department is located on the third floor of The Alfred and comprises outpatient clinics, investigation suites and an in-patient ward co-located with The Alfred Department of Cardio-Thoracic Surgery. It has close links with the adjacently situated BakerIDI Heart and Diabetes Institute. In addition to patient care the Department has an extensive research and education programme.
The department has 3 catheterisation laboratories in which a range of diagnostic, therapeutic and research procedures are performed. These include coronary and peripheral arterial imaging and intervention, haemodynamic assessments including pressure-volume loops and responses to exercise, device implantation, structural intervention, and cardiac biopsy. The department of electrophysiology offers a range of arrhythmia services which include catheter ablation for complex arrhythmias including atrial fibrillation. The Department is also recognised locally and internationally as a centre of excellence in cardiac magnetic resonance (CMR) imaging, with approximately 1000 CMR scans performed each year.
The Heart Failure/Heart Transplant Service is the only programme in Victoria offering all modalities required for heart failure care from diagnosis through to mechanical circulatory support and transplantation. The programme offers a multidisciplinary approach to care including nurse co-ordinators, allied health and cardiac rehabilitation programmes.
The Structural Heart Program at The Alfred involves transcatheter treatment of non-coronary cardiac defects. This includes valvular heart disease and congenital anomalies. Services provided include: transcatheter aortic valve replacement with the largest Corevalve program in Australia, percutaneous atrial septal defect closure, balloon aortic and mitral valvuloplasty, PFO, PDA and other cardiac defect closure, novel devices for the treatment of cardiac failure, first in man studies with new cardiac technologies and renal denervation for refractory hypertension.
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Prince of Wales Hospital, Sydney, NSW
The Eastern Heart Clinic was first established at the Prince Henry Hospital in 1991 before moving to the present location at the Prince of Wales Hospital (POW) Randwick Campus in 1998. The unit has provided exceptionally high quality cardiac care to the local community and also to patients throughout NSW and nationally for over 20 years. Founded in 1850s, the POW Hospital itself has built an international reputation as one of Australia’s finest public teaching hospitals with a broad array of medical and surgical services. Not only a centre of clinical and teaching excellence, the hospital is actively involved in cutting edge research and has traditionally had the only phase I research facility in the southern hemisphere.
The Eastern Heart Clinic (EHC) has four contemporary catheterization laboratories performing over 5000 diagnostic and therapeutic cardiac procedures annually confirming the unit as one of the busiest and most experienced in Australia. Located within the POW Public Hospital, the EHC is fully integrated with the Department of Cardiology and Cardio-thoracic surgery and the University of New South Wales and is also a partnership member of the Health Science Alliance on the greater POWH Randwick Campus. The positive benefits of this integration is reflected in highly developed pathways of care such as those for patients presenting with STEMI undergoing primary PCI and correspondingly associated with some of the best clinical outcomes in NSW.
An exceptionally diverse case-mix of complex interventions and patients treated in the unit contribute to the dynamic and unique clinical environment. High volume complex coronary interventions remain an integral part of the clinical service with a particular focus on high-risk, LMS, bifurcation and CTO PCI. Procedural outcomes are enhanced by the evolving use of intra-coronary imaging and physiological assessment and prospectively documented through a sophisticated clinical outcomes evaluation process. Separately, a long tradition in structural heart intervention with PTMV, balloon aortic valvuloplasy, PFO and ASD closure has more recently been enhanced by a rapidly growing TAVI program. Diagnostic and therapeutic electrophysiological procedural numbers continue to develop particularly with the growing need for complex interventions for atrial fibrillation and ventricular arrhythmias. Device implantation (PPM, CRT, AICD and loop recorders) similarly plays a significant clinical role as does the performance of chronic extraction lead procedures with the EHC a designated state and national referral site.
The unit plays a significant role in the education of our UNSW medical students, advanced trainees in Cardiology, interventional fellows and also EHC employed nursing staff. Similarly the EHC has a long-standing commitment to clinical research with a particular focus in research years to new stent design and technology (particularly assessing the performance of bioresorbable scaffolds), strategies (simple and complex) for the treatment of bifurcation disease, revascularization strategies in multi-vessel disease, minimizing radiation dosage in the catheterization laboratory, TAVI performance and renal denervation in patients with refractory hypertension.
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