How to keep 99.68% of your patients alive? A conversation with cardiac surgeon Dr Shakil Farid

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) predicts the risk of in-hospital mortality of the patient after cardiac surgery. It takes into account a variety of patient factors—age, health, comorbidities etc — and predicts how likely a patient is to survive a heart operation. 

An analysis of data from the National Adult Cardiac Surgery Audit of UK from 2021 to 2024 found that out of the 317 surgeries performed by Bangladesh-born Dr Shakil Farid during and after the challenges of the Covid-19 pandemic, his patients' survival rate was an astounding 99.68%. 

The current Consultant Cardiac and Aortic Surgeon at the world-famous Royal Papworth Hospital in Cambridge, United Kingdom, has achieved something few have even in an advanced health system like the UK. 

Dr Farid believes it's about good team work and a national-level healthcare system that can bring such results.   

"Cardiac surgery is not only dependent on the technical skills of the surgeons," Dr Farid said, adding, "It's about consistently achieving outcomes that surpass what's expected, especially in high-risk cases, by meticulous preoperative and postoperative planning and having excellent teamwork." 

Access of the patients to a specialised cardiac surgical unit is also important. The population of England is 60 million and there are around 30 to 35 cardiac centres, which are strategically located in different geographical areas across the UK to serve the population. 

"There are around 400 cardiac surgeons in the UK and around 25,000 -30,000 cardiac surgeries are performed annually", Dr Farid added.

Contrast that to Bangladesh, where access to specialised cardiac care is limited. Despite being a country of 170 million people, 32 centres currently offer cardiac surgery, and 24 of them are concentrated in the capital, Dhaka. 

The numbers are also staggering—11,000 surgeries are performed annually, but it's still far from enough for a country of that size.

"Bangladesh needs more centres, more surgeons, and more specialists supporting the patients with cardiovascular diseases," Dr Farid stressed, "Patients shouldn't have to travel hours, or even days, just to get to a cardiac surgeon. We need equitable access to care."

Born and educated in Bangladesh, Dr Farid honed his skills in various Bangladeshi hospitals, including Dhaka Medical College Hospital, BIRDEM and Ibrahim Cardiac Hospital and Research Institute. He earned his MBBS from Salimullah Medical College Hospital in 1999.

His journey took him to the UK in 2005. He has been trained in world-class cardiac centres such as Cambridge, London, Manchester and Brussels. Over time, he became one of the leading cardiac surgeons in Europe. 

While he was at Oxford University Hospitals, he established the complex aortic arch replacement using a frozen elephant trunk. After three years as a consultant surgeon at Oxford University Hospitals, he joined Royal Papworth in 2021. 

Ever since, Dr Farid has been performing life-saving operations with an enviable success rate. Royal Papworth Hospital is one of the biggest centres in the world for heart-lung transplant surgery, and complex aortic and mitral surgery.

Building a team that wins

For a successful cardiac operation, a surgeon needs at least seven or eight team members during the procedure. The role of everyone, from preoperative to recovery, is crucial to ensuring the best outcomes.  

"You can't achieve these results alone," he insists. "Cardiac surgery is a team effort. I rely on anaesthetists, cardiologists, intensivists, perfusionists, nurses, infection control team, physiotherapists and other members of the multidisciplinary team in order to thrive for excellence."

Dr Farid notes that in countries like Bangladesh, many of these supportive roles are underdeveloped and the concept of teamwork needs to be established more.

"The entire ecosystem matters," he said, "You need physiotherapists, dieticians, a robust cardiac rehabilitation programme—every expert has a role in getting the patient back to their feet."

Super-specialisation and improving cardiac care in Bangladesh

Dr Farid is a firm believer in the power of specialisation. At top cardiac centres worldwide, including his own, surgeons focus on highly specific areas. 

"In the UK, we have cardiac surgeons who specialise in the following subspecialties: complex aortic surgeries: mitral valve repairs, heart transplants and congenital heart surgery" he explained, "This kind of specialisation ensures that the patients get the best possible care for their specific condition."

"Access to adequate training is a major issue. We, the expatriate doctors, have created a trust foundation called 'Planetary Health Academia' through which we are making provisions for Bangladesh cardiac surgeons to be trained abroad," he said.  

He added that they have been providing travel fellowships to Bangladeshi cardiac surgeons so that they can come aboard and get hands-on experience in advanced surgical techniques. 

The trust foundation also organised the London Core Review Course in Dhaka in February 2024, which was well attended by the cardiac surgical trainees from different hospitals in Dhaka.

EuroSCORE: A critical benchmark for cardiac surgeons

Dr Samer Nashef, a famous surgeon from Royal Papworth Hospital, Cambridge was the pioneer of developing EuroSCORE, which is widely used throughout the world now. 

"It keeps surgeons and cardiac institutes accountable and helps constantly improve outcomes as it acts as a benchmarking tool," said Dr Farid. 

"This is not just about predicting the risk-adjusted mortality, but also an important tool for informing the patient about the risks associated with a cardiac surgical intervention; an integral part of informed consent," said Dr Farid. 

"When I explain to a 50-year-old patient with critical coronary artery disease needing CABG [Coronary artery bypass graft surgery] that they have a 0.5% risk of dying after surgery, it helps them to make an informed decision." 

He continued, "Contrast that with an older, sicker patient needing complex combined cardiac surgery—maybe an 85-year-old diabetic and asthmatic with poor mobility—whose risk might be over 10%. These numbers are invaluable in planning treatment [for the doctors] and enabling the patient to formulate an alternative management plan."  

This risk prediction tool can compare and match the particular patient with thousands of patients' profiles saved in the central database. It also forms an important part of the surgeon's result monitoring. 

"So, when one takes into consideration the risk vs benefit of the procedure, offering surgery to the otherwise fit 50-year-old justifies the surgical treatment," explained Dr Farid.  

Dr Farid believes similar monitoring systems in countries like Bangladesh could revolutionise the healthcare system. "We don't have any data-driven way of assessing a surgeon's results as well as outcome following cardiac surgery in Bangladesh," he pointed out. 

"A results monitoring system based on the risk-adjusted mortality following a cardiac surgery, similar to the one followed by the Society for Cardiothoracic Surgery in Great Britain and Ireland, will ensure transparency and improvement across the board. 

The first step will be to develop a database in Bangladesh with all the relevant patient related information stored in it," he added.