A word with Cardiovascular Director Malcolm Underwood

We take you into the heart of Cardiovascular Care at Auckland City Hospital. Cardiovascular Director, Malcolm Underwood, shares his insights into advancements here and around the world, which are transforming heart and lung care. Malcolm reveals his team’s mission to improve outcomes for NZ’s critical heart and lung patients, and explains how extra funds could make a big difference.

As a public service, we have a budget constraint, which you can’t ignore. . . .I think part of our job is looking for innovative ways to fund things that might not initially come under the umbrella of government funding.

Can you introduce yourself and tell us a bit about what you do?

My background is in cardiac surgery. I trained in the UK and Europe; I was a senior lecturer and then consultant at the Bristol Heart Institute for seven years. In 2005, I moved across the world to lead the Cardiothoracic Department at The Chinese University of Hong Kong, initially for a year-long sabbatical, but I ended up staying for 16 years to make the most of all the opportunities.

I was approached twice by Auckland City Hospital to lead Cardiovascular Care; the second time, I felt ready for my next challenge, so I’ve been in this position for 18 months.


What are the best and most challenging parts of your job?

One of the best things about my role is the amazing groups of people to work with – medical teams, nursing teams, Allied Health and the other services we need to develop the treatments we provide, like the perfusionists, who support patients during open heart surgery or when ECMO life-support is necessary.

As for the challenges, it’s a big job, it’s a big hospital department. As a public service, we have a budget constraint, which you can’t ignore.

Publicly-funded healthcare systems have limitations, and the Government and Ministry must balance lots of difficult equations in terms of how they use taxpayers’ money, so we definitely have to work within those constraints and do the best we can. But, I think part of our job is looking for innovative ways to fund things that might not initially come under the umbrella of government funding, and adopting this mindset will give us opportunities to introduce and develop innovations that will ultimately benefit New Zealand’s population.


What attracted you to Auckland City Hospital?

The attraction was three-fold. One is that it’s unique in the world – bringing together cardiac surgery, cardiology, vascular surgery, intensive care and anesthesia all under one directorate. As we look forward, towards embracing new technologies and developing better treatments for patients with heart and lung disease, we need multidisciplinary teams working together. Having one team makes it a much easier prospect going forward.

Secondly, in the 1970s-80s, Auckland’s Cardiovascular Care department (then based in Greenlane) was a huge player internationally in cardiac surgery and cardiology. A cardiac surgeon here, Brian Barratt-Boyes, was globally very famous and co-authored a cardiac surgery textbook with world-renowned John Kirklin from Minnesota’s Mayo Clinic, which became our bible.

Another attraction of Auckland City Hospital was that, working in Hong Kong, we had very distinct cultural groups to provide for. The capacity to protect the indigenous people and provide equal ability for them to access health facilities drew a lot of parallels with New Zealand and the Māori and Pasifika communities. In healthcare I’ve always thought, if you get it right for the most vulnerable, you’ve probably got it right for nearly everybody.

This job was an exciting opportunity to build on the amazing things already done here, and look at the path forward to get us back onto the international stage, which is demanded by the skills and treatments we provide.


Why is the Cardiovascular team at Auckland City Hospital so important to New Zealanders?

Firstly, we provide national services in areas like heart and lung transplants, life support systems that become your heart and/or lungs, and innovations such as Heart Transport Box, which significantly expands the donor heart pool and improves patient outcomes.

We bring people from all over New Zealand to give them the life-saving heart and lung treatments they need.

Secondly, our commitment to training future healthcare professionals ensures a sustainable pipeline of talent, which benefits the entire country; and our focus on clinical excellence, and adherence to international standards, gives patients confidence in the care they receive.

At Auckland City Hospital, we are fortunate to have some of the world’s top surgeons and clinicians who continuously push the boundaries of cardiovascular care.

We are also at the forefront of clinical trials, particularly in areas like heart transplants, where our innovative approaches are paving the way for better outcomes.


How many patients have been cared for in the past year, and for what conditions?

Year-to-date, we project about 950 open-heart surgery cases, which is a significant volume. In interventional cardiology – procedures like angioplasty – we also see high figures, likely in the 900s.

Additionally, innovative procedures like percutaneous aortic valve replacement (around 250 patients annually) are notable advancements. There have been extraordinary innovations in this area, such as the development of nurse-led sedation for procedures, moving patients out of the operating room and into a more relaxed environment. Vascular surgeries, focusing on major blood vessels, account for around 800-900 cases annually.

One impressive aspect of our hospital is the dedication to documenting clinical outcomes and benchmarking them against international registries across all specialties. This ensures that we maintain high-quality care and meet international standards, providing reassurance to the New Zealand population.


Can you give us an overview of the Cardiovascular team’s impact in the past decade?

Over the past decade, the Cardiovascular Care team at Auckland City Hospital has made significant strides in advancing heart and lung care.

We have achieved remarkable clinical outcomes, with our surgical and interventional procedures consistently meeting or exceeding international standards.

Secondly, our commitment to innovation has led to the adoption of cutting-edge technologies and techniques, such as percutaneous valve replacements, improving patient outcomes and expanding treatment options.

Lastly, our dedication to education and research ensures we remain at the forefront of cardiovascular medicine, driving continuous improvement and excellence in patient care.


If funding limitations weren’t a factor, what more would you like your team to do?

Without funding limitations, we would prioritise investments in innovative technologies and research initiatives aimed at further improving patient outcomes and expanding treatment options.

This could include the development of minimally invasive procedures for complex valvular pathologies and the establishment of collaborative partnerships with academic institutions to accelerate the translation of research findings into clinical practice.


How can Kiwis get behind your team and accelerate its incredible work?

A degree of support from the public would be invaluable to kick-start new treatments and innovations that would be of immense value for the future of cardiovascular care in New Zealand.

Anyone can support our team by clicking here and donating to Cardiovascular Care. Your contribution will help us invest in new equipment and fund research to ensure we continue to enhance the care and health of communities across the country.

Click here to find out more about Cardiovascular Care at Auckland City Hospital.


Malcolm Underwood

Click here to watch Underwood explain why cardiac advancement requires investment.