The National Adult Cardiac Surgery Audit (NACSA) collects data on all major heart operations carried out on NHS patients in the UK. The audit is managed by NICOR, with clinical direction and strategy provided by the Society for Cardiothoracic Surgeons (SCTS) and the Project Board.
The NACSA is part of the National Clinical Audit Patient Outcomes Programme (NCAPOP), which is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and funded by NHS England.
Anthony Bradley, NACSA project manager
The National Adult Cardiac Surgery Audit (NACSA) collects consecutive operation data from all NHS hospitals in the UK that carry out adult heart surgery. A number of Irish and UK private surgical units also voluntarily submit data.
The project, which has been running since 1977, enables secure collection and analysis of cardiac surgery data, as well as long-term tracking of mortality. Participation in the audit is mandatory for relevant English and Welsh hospitals as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).
The project aims to improve the clinical outcomes for cardiac surgery patients by making publicly available comparisons of local hospital and consultant surgeon results against national benchmarks.
Analysis of NACSA data is reported to participating hospitals, Cardiac Networks, NHS regulatory bodies such as the CQC) and the public. This drives the development of cardiac surgery services by encouraging shared learning and the improvement of identified poor performance. The audit is also designed to enhance understanding of clinical trends and develop risk adjustment models for outcome measures, such as mortality.
The clinical lead for this audit is Andrew Goodwin, a consultant cardiothoracic surgeon at the James Cook University Hospital. Specialist clinical knowledge and clinical leadership for NACSA is provided by the Society for Cardiothoracic Surgeons (SCTS) and the audit Project Board.
NACSA is managed by NICOR with specialist clinical knowledge and clinical leadership provided by the Society for Cardiothoracic Surgeons (SCTS) and assisted by the audit steering group.
The aorta is the major blood vessel leaving the heart and it carries blood to the rest of the body. The most common medical condition to affect the aorta is an aneurysm. Aneurysms are blood filled bulges in the wall of a blood vessel. As an aneurysm grows in size, it is increasingly likely to rupture, resulting in severe bleeding that can be fatal. Surgery may involve replacing the section of the aorta that has been weakened by the aneurysm with a bypass graft.
Another common condition affecting the aorta is aortic dissection. This occurs when a tear in the aorta’s inner wall causes blood to flow between the layers of the wall, forcing those layers apart. This can block the vessels that branch off from the aorta, damage the aortic valve or even tear the aorta completely open. This is a medical emergency and can rapidly lead to death. The requirement for surgery usually depends on the location of the dissection. If it occurs where the aorta rises out of the heart or curves back down (known as the ascending aorta and aortic arch), surgery is more likely to be necessary than if it occurs where the aorta travels downwards (the descending aorta).
If the aorta is damaged beyond repair, one of the following operations may be performed:
Composite root replacement
This procedure is performed when both the aortic root and the aortic valve require replacement. It involves stitching (suturing) on a graft to replace the damaged section of the aorta. This graft has an artificial valve (see ‘Valve replacement/repair’ above) pre-mounted onto it.
This procedure is used particularly if the dissection occurs above the place in the ascending aorta where the coronary arteries branch off. It involves cutting out the narrow part of the aorta and replacing it with synthetic material.
Coronary Artery Bypass Graft (CABG)
The coronary arteries are the vessels that deliver oxygen-rich blood to the heart muscle. Certain medical conditions can cause these vessels to become narrowed or blocked, which restricts the flow of blood into the heart muscle.
If the arteries become sufficiently blocked, the heart cannot get enough oxygen from the blood to work properly. When this happens temporarily a person may feel chest pain, known as angina. If the heart doesn’t get the oxygen it needs for longer periods, the heart muscle may become permanently damaged by a heart attack.
CABG surgery is designed to relieve angina and reduce the risk of heart attack in patients for whom medicines are ineffective or cannot be tolerated due to side effects. It involves taking an artery or vein from elsewhere in the body and attaching (grafting) it to the diseased artery above and below the point of narrowing. This allows the blood to flow around (bypass) the blockage and reach the heart muscle without restriction. This procedure can be performed on more than one diseased artery within the same operation if necessary. A patient will be put to sleep using general anaesthetic for this surgery, which can either be performed by stopping the heart using ‘bypass’, or by stopping only the part of the heart muscle that is going to be operated on (known as ‘off-pump’ surgery).
For more information please go to the British Heart Foundation Website.
The heart has four valves, which open and close to regulate the flow of blood through different parts of the heart, as well as ensuring that it only travels in one direction. The aortic and mitral valves are on the left side of the heart and the pulmonary and tricuspid valves are on the right.
A condition called valvular heart disease can cause these valves to either become narrowed or leaky. Narrowing of a valve (stenosis) prevents blood flowing properly though it, whilst a leaky valve allows blood to flow in the wrong direction. In both cases the result is that the heart cannot get enough blood in the areas that it is needed.
If surgery is required to restore the flow of blood through these valves a patient will either have their valve(s) repaired or replaced. Valves tend to be repaired if they are leaky but not seriously damaged, whereas a more severely diseased valve might be replaced. Valves are replaced with valves that are either mechanical (man-made) or tissue (animal).
Valve repair can involve separating fused valve flaps, removing, reshaping or adding tissue.
For more information please go to the British Heart Foundation website.