Our Cardiac History
Origins of Cardiac Services at the San
Amongst private hospitals in Australia, Sydney Adventist Hospital (the San) has been a pioneer in many aspects of medicine and surgery. In the 1970s, the concept of establishing a comprehensive cardiological and cardiac surgery service – to include diagnostic angiography, cardiac surgery and rehabilitation – was undoubtedly one of the most exciting and radical innovations the hospital proposed since it opened in 1903. At that time, no private hospital in Australia had a comprehensive cardiothoracic program.
Former San CEO, Dr Herbert (Bert) Clifford, recalls how the cardiac program at the San progressed from idea to reality.
"The notion of introducing heart surgery at the San arose out of an exchange in the mid-1970s between surgeon colleague, Dr Don Wilson, and myself. Dr Wilson, an Australian-American, was a San-employed consultant in general surgery. He was also a qualified cardiothoracic surgeon, trained at Loma Linda University Hospital in California. Having performed heart surgery in the private sector in the United States, he saw the potential for its introduction to the San. It was a vision he cherished and shared with the San administration."
Dr Don Wilson performed the first electronic cardiac pacemaker insertions at the San between 1974-1975.
After the San conducted a thorough investigation and detailed research into establishing a cardiac program, in September 1978 the Hospital Board gave the go-ahead for the cardiac program. No expense was spared in setting up a modern, fully-equipped cardiac catheter laboratory, cardiac operating theatre, upgrade of intensive care, and acquiring the surgical and perfusion equipment necessary to undertake open-heart surgery.
1979 - cardiac procedures COMMENCED
On May 21, 1979, the first cardiac catheterisation procedure was performed at the San by Dr Eddie Eikens. Nine days later, the first open-heart surgery was performed at the San by Dr Don Bennett.
Dr Clifford noted there was a presumption in that era that a private hospital couldn’t do complex, sophisticated procedures like cardiac surgery.
"Starting cardiac surgery at Sydney Adventist Hospital was a challenging innovation because at that time, no other free-standing private hospital performed complex sophisticated procedures of that kind, and there was a presumption they couldn’t. The San was the first private hospital to break that mould. We established the cardiac program and it proceeded well, with world-standard results for outcomes and recovery times for patients. We commenced with only one cardiac surgeon and one procedural cardiologist, but demand for heart surgery – particularly coronary artery surgery – was escalating rapidly, and more consultants were soon brought into the program. Emphasis continued to be placed on the highest standards. The start of cardiac surgery at the San was an innovation that set a precedent for the development of specialisation in the private hospital sector throughout Australia. Following the cardiac initiative, the San implemented other advanced services not normally provided by private hospitals at that time – such as radiology and oncology."
Following this first procedure, demand increased with 53 complex heart operations including valve replacements and coronary artery bypasses completed by December 1979.
The San’s comprehensive cardiac service now includes diagnostic, structural and interventional cardiology; electrophysiology; cardiac surgery (open-heart surgery as well as minimally-invasive cardiac surgery – including robotics) and rehabilitation.
Building on the strong foundations built by the surgeons, cardiologists, nursing and allied health staff who have contributed to the success of the cardiac program over the years, today’s highly-skilled and respected cardiac team continue their pioneering and life-changing work. This combined with cutting-edge technology and first-rate facilities ensure the San’s cardiac service remains at the forefront in this field.
1983 – 1,000th cardiac catheter patient
Mr McGregor of Concord was surprised when he received a special cake, arranged by the Nursing Unit Manager of the Cardiac Catheter Lab, Doreen Clifford, to celebrate the fact that he was the 1000th patient in the Cardiac Catheter Laboratory. He was very happy he had this procedure, as it was discovered he needed emergency heart surgery and was operated on the next day.
1983 – 500th coronary bypass patient
On May 9, 1983 the cardiac surgical team performed their 500th procedure. Since the commencement of the cardiac surgery program in May 1979, many new developments had occurred – new techniques, new equipment, new personnel. These components combined to achieve a very successful undertaking. The San was already widely acknowledged as one of the leaders in cardiac care within New South Wales, with surgical candidates often referred from rural and regional NSW, interstate and overseas.
By 1985 the cardiac unit was performing up to 12 coronary bypasses and 15-20 angiograms each week – aside from treating patients with chest pain or heart attacks.
1990 – 10,000th cardiac catheter procedure
The San's Cardiac Catheter Laboratory performed its 10,000th cardiac catheter procedure in 1990, and staff justifiably celebrated. While coronary angiography represented the majority of cases, increasing numbers of angioplasties, electrophysiology studies and pacing electrode insertions were also being performed.
1990 – 500th angioplasty procedure
The 500th percutaneous transluminal coronary angioplasty (PTCA) was performed in the Cardiac Catheter Laboratory. There was a marked increase in the number of PTCAs being performed at that time as the procedure began to be featured prominently in the management of patients with coronary artery disease. During the PTCA procedure, a small dilating balloon is positioned in severely narrowed sections of coronary arteries. It is then inflated to a precise diameter and pressure, dilating the lesion and improving blood flow.
1991 – 5,000th open-heart operation
By 1991, 5,000 people had placed their hearts in the hands of Sydney Adventist Hospital’s renowned heart surgery team. Following the 5,000th procedure, theatre staff celebrated this incredible achievement with surgeon Dr Alan Gale, anaesthetist Dr Peter Lindberg and perfusionist Dr Herbert Clifford. The operation was a coronary artery graft on Mr Herbert Wilson of Newport, who was under the care of cardiologist Dr David Grout.
1992 – new cardiac rehabilitation facilities opened
In line with the San’s focus on wholistic health and health promotion, cardiac rehabilitation was one of the key elements of establishing a comprehensive cardiac program at the hospital. Providing cardiac education for patients pre-and-post procedure, as well as information about exercise, diet, smoking cessation and stress management all formed part of the cardiac rehabilitation program. Over the years this service grew, and in 1992 a new cardiac rehabilitation facility opened, including a gymnasium and exercise and assessment areas.
1993 – 1,000th angioplasty procedure
Mr Henry Riley of Dural became the San’s 1,000th coronary angioplasty patient in April 1993. The operation was performed by Dr Tom Gavaghan, who worked in partnership with Dr David Grout, the cardiologist who performed the San’s first – and one of Sydney’s earliest – angioplasties in 1982. It was understood that the San had performed the highest number of angioplasties in any NSW private hospital at that time.
1996 – 1st keyhole cardiac surgery Procedure
Cardiothoracic surgeon, Dr David Marshman, performed the first keyhole cardiac surgery at the San, treating patient Mr Simon Der Stephanran.
1997 – Dr Alan Farnsworth performs his 2,000th open-heart procedure
The Hon Andrew Manson MLC, a member of the New South Wales Upper House was cardiothoracic surgeon Dr Alan Farnsworth’s 2,000th open-heart case at the San. "As this was my first major operation, I was very nervous and I questioned Dr Farnsworth about his experience," said Mr Manson. "He told me he’d done one or two open-heart operations! I was surprised and delighted to find out that I was his 2,000th case at this hospital."
1998 – 10,000TH open-heart operation
When Mrs Jean Fitzmaurice arrived at the San for open-heart surgery, she never dreamed that she would become a very special patient. In August 1998, she became the 10,000th patient to undergo open-heart surgery at the San. Cardiothoracic surgeon Dr Don Ross, who by then had performed more than 1,200 open-heart procedures at the San, replaced Mrs Fitzmaurice’s aortic valve – an operation that took two hours.
2019 – 40 years of cardiac services
To celebrate 40 years since the San commenced Australia’s first comprehensive cardiac surgery program in a private hospital, a super-sized ‘human heart’ was formed on the hospital’s front lawn by more than 200 people at the anniversary party – including pioneering heart surgeons, doctors, nurses and local school children. Some of the influential and early cardiac team members were still, or until recently, had been working at the San and many attended the celebration.
San cardiothoracic surgeon Dr Alan Farnsworth recalled that although major public hospitals had cardiac units in 1979, patients could end up waiting significant times for cardiac surgery in public hospitals.
"With cardiac surgery it is important to get the right service at the right time. Unfortunately, there were people who were on public hospital waiting lists who never made it. The San establishing the first private, stand-alone cardiac surgical service was a very significant development. It helped meet a community need for more cardiac services. It took a lot of daring to do." said Dr Farnsworth.
Dr Farnsworth also said the San was able to deliver a first-rate service from the beginning because the hospital had the expertise, technology, facilities and the appropriate nursing staff, despite the fact cardiac surgery and recovery is complex and complicated.
"They had to get it right and they did. I felt just as comfortable at the San as I did working at other hospitals around Australia, the USA or in the UK. The scrub sisters, theatres nurses, wards and intensive care unit staff all made it easier. With a cardiac service like this, it’s big deal to make everything work… and the San did it. There had been some scepticism amongst medical practitioners about whether it could be done but when they saw the quality of what was being done, they rapidly changed their minds. Other facilities then copied what the San had put in place."
Dr Clifford said the ‘human heart’ celebration was a wonderful chance to return to the San to celebrate. "Thousands of cardiac surgeries and 40 years later it is wonderful to be here to celebrate today at this happy – and fun – event."
2022 – Australia’s first Mini-CAVIAAR Procedure (aortic root remodeling with external subaortic annuloplasty)
2023 – Completion of Australia’s first Robotic Aortic Valve Replacement
Professor Tristan Yan and his team at the San ushered in a new era of cardiac surgery in Australia in 2023 with their pioneering work to introduce robotic aortic valve replacement surgery – widely considered an Australian medical milestone. This groundbreaking procedure has not only created a new minimally-invasive treatment option for patients with aortic valve disease, but also broadened the clinical application of robotic platform in the field of heart surgery. Since then, the robotic program at the San has grown and seen other landmark first-in-Australia achievements by Professor Tristan Yan and his team including:
- Minimally invasive aortic root replacement ‘Mini-Bentall procedure’
- Minimally invasive aortic arch and ‘frozen elephant trunk’ procedure
- Minimally invasive aortic valve sparing root replacement ‘mini-David’ procedure
- Robotic aortic valve replacement
- Robotic double aortic and mitral valve replacement
- Robotic trans-mitral septal myectomy
- Robotic parenchymal sparing bronchial sleeve resection
Open Heart International (formerly Operation Open Heart)
Over many decades, San nurses and doctors have participated in volunteer surgical outreach visits to developing countries, to facilitate surgery and training.
In 1973, four San personnel – surgeon Dr Bert Clifford, anaesthetist Dr Warren Millist, and nurses Cheryl Borgas and Dawn Maberly – travelled to Atoifi Adventist Hospital in the Solomon Islands to perform general surgery much needed at the time. This trip was made in support of former San nurses who were living and working at Atoifi. A second surgical visit followed in 1978. Little did these small teams know at the time, but these surgical trips were the early forerunners of what would later become a formal, organised surgical outreach program run by the San.
In 1983, Russel Lee, an intensive-care nurse from the San, visited Tonga and noted the high incidence of rheumatic heart disease caused by rheumatic fever. He returned to the San and over the next few years, he and his colleagues began fund-raising and planning for a cardiac surgical trip to Tonga.
In 1986, a team of 45 people – including San surgeons, anaesthetists, perfusionists, nurses and support staff – travelled to Tonga to perform heart surgery and run training and health-education programs. This was the start of Operation Open Heart, which later became Open Heart International – and continues to this day.
In the years since, the San and ADRA run volunteer surgical outreach program expanded to include other specialties – not just cardiac surgery – and visited many countries including Papua New Guinea, Nepal, Myanmar, Rwanda, China, Mongolia, Vietnam, Vanuatu and Fiji, to provide surgery and training.
