**6. References**

88 Perioperative Considerations in Cardiac Surgery

Stockholm, where each centre's anonymised activity and outcomes are presented along with agreed educational topics relating to recent experience or anticipated innovation. Again, this facilitates joint learning and service improvement in a very open and

National commissioning of the adult ECMO service enabled the definitive trial of ECMO in adults with potentially reversible severe respiratory failure to be commissioned jointly with the National Coordinating Centre for Health Technology Assessment (now part of the National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre). The results of this trial were published in the Lancet in September 2009 (Peek et al., 2009) and as a NIHR Health Technology Assessment Monograph in 2010 (Peek et al.,

**4. Ventricular Assist Device (VAD) for bridging to heart transplantation** 

The provision of Ventricular Assist Devices (VADs) as a bridge to heart transplantation has been available at Papworth Hospital NHS Foundation Trust, the Royal Brompton and Harefield NHS Trust and The Newcastle upon Tyne Hospitals NHS Foundation Trust since 2002, and more recently at the other cardiothoracic transplant centres in the UK. Data on implantation, explantation, death and ongoing survival are recorded by NHSBT as part of

NHSBT provide monthly reports to the National Specialised Commissioning Team on VAD activity and outcomes for each of the national centres. These data are shared with all centres at twice yearly meetings of the National VAD Forum convened and chaired by the National Specialised Commissioning Team and where representatives from each of the national cardiothoracic transplant centres are present. This allows an open and transparent forum for shared learning and has been the vehicle for developing the commissioning policy for expansion of the VAD service within the national cardiothoracic transplant

Additionally, the UK Cardiothoracic Transplant Audit publishes the 30-day, 90-day, 1-year, 2-year and 3-year mortality for those individuals receiving short-term and long-term VADs as a bridge to transplantation, and highlights the survival experience with these devices. The audit also presents data on those VADs used to mechanically support a recently transplanted heart where primary graft failure is experienced, once again informing the development of the service and supporting quality improvement. These data are reviewed

A recent innovation is development of a much more comprehensive and bespoke VAD Database overseen by NHSBT that will allow much greater understanding of the experience with long-term VADs and provide a rich repository for research. The three early providers of long-term VADs (Papworth Hospital NHS Foundation Trust, the Royal Brompton and Harefield NHS Trust and The Newcastle upon Tyne Hospitals NHS Foundation Trust) are completing the population of the database with all historical cases receiving a long-term VAD, whilst all current providers are contributing to data entry on all prospective cases

This will provide anonymised data on the entire national cohort of patients receiving VADs and is expected to enable research to help further develop the evidence base in this rapidly

transparent setting.

the cardiothoracic transplant database.

at the twice yearly National VAD Forum meetings.

2010).

programme.

receiving a VAD.

changing technology.

Kenny, T. Jessop, E. Gutteridge, W. (2008) Monitoring clinical quality in rare disease services – experience in England. *Orphanet Journal of Rare Diseases,* 2008, 3:23 Available from < http://www.ojrd.com/content/3/1/23>

Klein, G. (1998) *Sources of Power: How people make decisions*, MIT Press, 0-262-61146-5, London


<www.rcseng.ac.uk/surgical\_research\_units/ceu/docs.html>

NHS Blood and Transplant. (2011) Available from<www.nhsbt.nhs.uk/about/index> NSCT (2008) Report of the external review of recent outcomes in the heart transplant service

at Harefield Hospital. Available from <http://www.specialisedservices.nhs.uk/document/review-recent-outcomes-inheart-transplant-service-at-harefield-hospital>
