The cardiac surgery department at the Clínico Universitario hospital, which is headed by José María Melero, is one of the busiest in Andalucía and carries out more heart operations than any other. Last year 422 highly complex operations took place here, the highest number since the unit opened 20 years ago. This has resulted in a shorter waiting list for surgery of this type.
Among the hospitals in the Andalusian Health Service, where does the Clínico stand in terms of heart surgery?
In terms of major heart surgery we carry out the most operations. Last year we did 422, which is the highest number since the unit opened 20 years ago. Figures like that don't just happen overnight. It is something we have achieved progressively over the past three years, with an annual growth of five per cent, because we have been able to increase slightly in efficiency.
How have you achieved this growth in the number of operations?
It has been through the joint efforts of the Administration and the efficiency of the medical professionals. We have managed our resources well and that has enabled us to increase our levels of activity and reduce delays. I must pay tribute to the cooperation and involvement of the whole heart unit, the anaesthesia service and the nursing staff.
How many operating theatres do you have?
For years we only had one, and we made the best of it that we could. Six months ago we were allocated a second one and that is when we were able to carry out more operations.
Since taking over as the head of the cardiac surgery unit, what challenges have you faced?
There are three fundamental types: firstly, to carry out more operations, which we are doing; secondly, to shorten the waiting time for surgery and continue to expand the services we offer; and thirdly to improve our results and make people aware of them. I believe our service is well positioned. Our results are very good and we have successfully introduced a series of new services, such as, for example, valve repairs, pump-free coronary surgery, minimally invasive surgery... We as a group always like to do new things.
How many heart surgeons are there in your service?
There are seven of us, which is a good number.
Do you use both operating theatres throughout the week?
For nearly 20 years we only had one. In the past two years we have been using it mornings and afternoons, from Mondays to Fridays. No other operating theatre in Spain has been used as much as ours. We have carried out nine operations in a single day sometimes, working from 8am to 8pm. However, for the past six months we have been able to use a second operating theatre for two mornings a week.
What are your results like?
We are in a good position among hospitals in Spain; our mortality rates are lower than the national average.
What are the most common heart operations?
The operations we do most are isolated coronory surgery and aortic valve replacements. We are committed to a type of surgery which improves patients' quality of life, which is why we try to repair the heart valves.
So it is better to repair someone's own heart valve than replace it with an artificial one?
Of course. In every way. Because of complications which can arise and so the patient doesn't have to take anticoagulants and other medication afterwards, and because the procedure lasts longer. We also carry out pump-free coronary surgery.
What is that?
It's an operation which is done without stopping the patient's heart and without needing to use an extra-corporal machine. When you do cardiac surgery, you have to connect the patient's heart to an extra-corporal pump, a machine which acts like their heart and the lungs. We carry out coronary surgery without the need for that equipment.
What is the average age of your patients? I suppose you normally operate on older people?
The average age is increasing; these are patients with many risk factors. That makes the operations more complicated.
Another technique which you use is called minimally-invasive surgery. What are the benefits of that?
Not many hospitals in Andalucía carry out this type of surgery. It involves repairing the aortic valve through small incisions, or repairing mitral valves through a small incision in the ribs. That is better for the patients: it is not the same to have a small wound as it is to have a large one. Also, with minimally-invasive surgery the patient doesn't end up with any broken bones, so there is less post-operative pain and they recover faster. We have been using this technique for three or four years now.