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Last Updated: Saturday, 20 October 2007, 23:46 GMT 00:46 UK
Inside Medicine: The cardiac surgeon
Mario Petrou, consultant cardiac and transplant surgeon
Mario Petrou does about 300 operations a year

In a series focusing on medical specialisms, Mario Petrou talks about his work as a consultant cardiac and transplant surgeon.

Cardiac surgeons operate on patients with abnormalities or defects of the heart.

A transplant surgeon removes the diseased heart or lungs from a patient to be replaced with a healthy donor heart or lungs. In some cases, a mechanical device is inserted to support the patient until transplantation.

WHAT IS YOUR JOB?

I am a consultant cardiac and transplant surgeon with the Royal Brompton & Harefield NHS Trust.

My speciality as a surgeon is to operate on adult patients with a variety of conditions affecting the heart.

In addition, I carry out heart and lung transplants.

I do about 300 operations a year.

The majority are adult cardiac operations. Very few are transplants - unfortunately we do not have enough donor organs available for the vast number of potential recipients.

WHAT IS THE MOST COMMON CONDITION?

The most common condition is coronary artery disease affecting the arteries supplying blood to heart.

Cardiac surgery has had quite a turbulent time over the last few years following the Bristol Inquiry
Mario Petrou
With time the coronary arteries become progressively narrow and blocked. As a result patients develop chest pain (angina) and/or suffer heart attacks.

Risk factors include smoking, high blood pressure, high cholesterol, diabetes and a strong family history of coronary artery disease.

A scan called a coronary angiogram is performed which shows-up the significant narrowings.

The patient is then referred to me and I perform a bypass operation to correct and restore the blood supply.

WHAT IS THE MOST COMMON PROCEDURE?

This is a coronary artery bypass grafting, also known as CABG (pronounced cabbage).

This procedure involves using the patient's spare arteries and veins to bypass the diseased coronary arteries in order to restore the blood supply to the heart. This usually takes the form of a triple or quadruple bypass.

The most popular artery used is the left internal mammary artery (Lima), sited inside the chest wall. Its use for CABG has been shown over the years to provide the best survival benefit.

The Lima secretes certain molecules and substances which protect the coronary artery it has been attached to, which helps keep it open for many years.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

The hardest thing about my job is probably the scheduling of patients from my waiting list.

If operations are cancelled for any reason, such as intensive care beds being occupied by patients for longer than expected, it creates a strain on the system.

It is very hard to tell patients that their operation has been cancelled, especially on the day of surgery. I always try to speak to the patient and family by going to the ward to explain the reasons why their operation could not go ahead at that time.

I will then reschedule surgery and treat the patient as a high priority.

WHAT IS YOUR MOST SATISFYING CASE?

I think it is very difficult to pick out individual cases.

In general, the most challenging patients are those who are high risk, extremely ill and have a poor prospect of recovery.

Heart monitoring
Cardiology focuses on the heart

This can include patients referred for CABG or valve replacement as well as transplant patients. Quite often there is no prospect for long-term survival without surgery.

When a complex operation goes well and I see patients in my clinic a couple of months later enjoying life and looking fantastic - that is extremely satisfying.

WHY DID YOU CHOOSE THIS SPECIALITY?

I went to medical school with the intention of becoming a surgeon. Once I saw cardiac surgery as a medical student I became fascinated.

In addition, I was inspired to train as a transplant surgeon by reading about the first ever heart transplant carried out by Dr Christiaan Barnard in Cape Town in 1967.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

No. I wouldn't actually.

My team and I operate on people who are very sick, and have many complex medical problems. Following successful surgery we see how their lives can be completely transformed.

I could never imagine doing anything else.

Cardiac surgery has had quite a turbulent time over the last few years following the Bristol Inquiry and we are now required to make our success rates public through the Healthcare Commission website.

Operating on patients who are extremely ill and who may have been turned away from other hospitals can affect overall success rates.

However, for the vast majority of patients, the results are excellent and they leave us with a much improved quality of life.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

If I hadn't chosen surgery I would probably have specialised in medical oncology.

Cancer is still a major challenge and one would think that over a 20 or 30 year career in medicine you would see a lot of medical breakthroughs.

But equally I would also have been happy as a GP.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

I think a lot of surgery, and particularly cardiac surgery, is influenced by technological advances. It is possible that in the future we will be using more mechanical assist devices such as artificial hearts and lungs for people with end-stage heart and lung failure.

Furthermore, there is a move towards replacing heart valves in a less invasive manner, for example without having to cut the breastbone, and this technology, which is still developing, is an area I am currently pursuing and very interested in.

CV - Mr Mario Petrou
1990: Graduated from University College Hospital and Middlesex School of Medicine
1996: Completed a PhD in Cardiac Surgery
1997: Began to specialise in cardiothoracic surgery at the Royal Brompton and London Chest Hospitals
2001: Specialised in transplantation at Papworth Hospital, Cambridge and awarded the Gold Medal for the FRCS (CTh) Part III examination




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