For many patients, the path to cardiothoracic surgery begins with a GP or specialist who recognises that medical management alone is no longer enough. Knowing when to refer, and to whom, can make a significant difference to patient outcomes. Mr Adrian Pick is a Melbourne-based cardiothoracic surgeon with over two decades of experience in minimally invasive cardiac and thoracic surgery. This article outlines clinical situations where a referral to Mr Pick is worth considering.
Atrial Fibrillation That Is Not Responding to Medical or Catheter-Based Treatment
Atrial fibrillation (AF) has become one of the most common cardiac arrhythmias managed in general and specialist practice. While rate control, rhythm control medications, and catheter ablation are first-line options for many patients, a significant proportion will continue to experience symptomatic episodes despite these approaches.
Surgical treatment for AF is now a well-established option and is far less invasive than it once was. Mr Pick performs minimally invasive AF surgery, including the TT-Maze procedure, through small keyhole incisions rather than a full sternotomy. This approach is particularly suited to patients with persistent or longstanding persistent AF who have failed catheter ablation, or those who are undergoing cardiac surgery for another indication where AF treatment can be addressed simultaneously.
A referral is appropriate when a patient has symptomatic AF that has not been adequately controlled with at least one antiarrhythmic agent or catheter ablation, particularly if they have a structurally normal or mildly diseased heart, are experiencing a reduced quality of life, or wish to explore curative rather than rate-control strategies.
Mitral Valve Disease Requiring Intervention
Mitral regurgitation and mitral stenosis are conditions that, once symptomatic or haemodynamically significant, often require surgical or procedural correction. Echocardiographic findings of severe mitral regurgitation, increasing left ventricular dimensions, or declining ejection fraction are established thresholds for referral to a cardiothoracic surgeon.
Mr Pick specialises in minimally invasive mitral valve surgery performed through a small incision between the ribs, avoiding the need for a traditional sternotomy. This approach offers comparable outcomes to open surgery with a shorter recovery and reduced postoperative pain. More than 90% of mitral valves can be repaired rather than replaced using this technique, which is generally preferred given the long-term advantages of repair over prosthetic replacement.
Referral is appropriate for patients with severe mitral regurgitation who are symptomatic, or asymptomatic patients who meet echocardiographic criteria for intervention. Patients who have been told they need mitral valve surgery and wish to explore minimally invasive options are also well suited to a consultation with Mr Pick.
Aortic Valve Disease
Aortic stenosis is increasingly prevalent in an ageing population. For patients who are surgical candidates, aortic valve replacement remains a durable and effective treatment. Mr Pick can offer both minimally invasive surgical aortic valve replacement and, where appropriate, transcatheter aortic valve implantation (TAVI) for patients who are at higher surgical risk.
A referral should be considered when a patient has severe aortic stenosis with symptoms such as chest pain, exertional dyspnoea, or syncope, or in cases of asymptomatic severe stenosis with declining ventricular function. Patients referred for a second opinion regarding their suitability for TAVI versus surgery are also seen regularly in Mr Pick’s practice.
Lung Nodules or Suspected Lung Cancer
The incidental detection of lung nodules on CT imaging is increasingly common. While many nodules are benign, the correct surveillance and management pathway is important. Mr Pick offers a rapid nodule assessment service for GPs and specialists who need timely review of a lung finding, without patients waiting months for an appointment.
Referral is appropriate in the following situations: a lung nodule that has grown on serial imaging, a nodule with features suspicious for malignancy on CT or PET, a tissue diagnosis of lung cancer where surgical resection is being considered, or a patient with a significant smoking history who would benefit from lung cancer screening.
On the thoracic side of his practice, Mr Pick performs keyhole lung surgery (VATS) including wedge resections, lobectomies, and pneumonectomies for lung cancer. He also manages interstitial lung disease requiring biopsy, pleural effusions including talc pleurodesis, and asbestos-related conditions including mesothelioma.
Patients Who Have Been Advised to Have Open Surgery and Want to Know Their Options
A meaningful part of Mr Pick’s practice involves second opinions. Patients who have been told they need open heart surgery, a sternotomy, or a conventional thoracotomy are often unaware that minimally invasive alternatives may be available to them. A consultation with Mr Pick can clarify what is technically feasible and help patients make a well-informed decision about their care.
How to Refer
Mr Pick consults at two locations in Melbourne: Peninsula Private Hospital in Frankston and Holmesglen Private Hospital in Moorabbin. He accepts referrals from GPs and specialists, and his practice accommodates patients with and without private health insurance.
Referrals can be directed to the practice by phone on (03) 9509 9577 or via the referral page at ctsurg.com.au/referrals. For urgent matters, including suspected lung cancer or rapidly changing cardiac symptoms, the team is available to assist with expedited appointments.
Mr Adrian Pick holds Fellowship of the Royal Australasian College of Surgeons in both General Surgery and Cardiothoracic Surgery. His advanced fellowship training was completed at the Mayo Clinic and the Toronto General Hospital.