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Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre

Published online by Cambridge University Press:  28 February 2019

Igor V. Polivenok
Affiliation:
Zaitcev Institute for General and Urgent Surgery, Kharkiv, Ukraine William Novick Global Cardiac Alliance, Memphis, TN, USA
Frank J. Molloy
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA
Christian L. Gilbert
Affiliation:
Penn State Health, St Joseph’s Hospital, Reading, PA, USA
Mark Danton
Affiliation:
Royal Hospital for Sick Children, Glasgow, Scotland, UK
Ali Dodge-Khatami
Affiliation:
Children’s Heart Center, Jackson, MS, USA
Sri O. Rao
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA
John P. Breinholt
Affiliation:
University of Texas Health Science Center at Houston, TX, USA
Marcelo Cardarelli
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA Inova Children’s Hospital, Fairfax, VA, USA
Jamie S. Penk
Affiliation:
Advocate Children’s Hospital, Chicago, IL, USA
William M. Novick
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA Department of Surgery, University of Tennessee Health Sciences Center-Global Surgery Institute, Memphis, TN, USA
Corresponding

Abstract

Background

Surgery for CHD has been slow to develop in parts of the former Soviet Union. The impact of an 8-year surgical assistance programme between an emerging centre and a multi-disciplinary international team that comprised healthcare professionals from developed cardiac programmes is analysed and presented.

Material and methods

The international paediatric assistance programme included five main components – intermittent clinical visits to the site annually, medical education, biomedical engineering support, nurse empowerment, and team-based practice development. Data were analysed from visiting teams and local databases before and since commencement of assistance in 2007 (era A: 2000–2007; era B: 2008–2015). The following variables were compared between periods: annual case volume, operative mortality, case complexity based on Risk Adjustment for Congenital Heart Surgery (RACHS-1), and RACHS-adjusted standardised mortality ratio.

Results

A total of 154 RACHS-classifiable operations were performed during era A, with a mean annual case volume by local surgeons of 19.3 at 95% confidence interval 14.3–24.2, with an operative mortality of 4.6% and a standardised mortality ratio of 2.1. In era B, surgical volume increased to a mean of 103.1 annual cases (95% confidence interval 69.1–137.2, p<0.0001). There was a non-significant (p=0.84) increase in operative mortality (5.7%), but a decrease in standardised mortality ratio (1.2) owing to an increase in case complexity. In era B, the proportion of local surgeon-led surgeries during visits from the international team increased from 0% (0/27) in 2008 to 98% (58/59) in the final year of analysis.

Conclusions

The model of assistance described in this report led to improved adjusted mortality, increased case volume, complexity, and independent operating skills.

Type
Original Article
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Polivenok IV, Molloy FJ, Gilbert CL, Danton M, Dodge-Khatami A, Rao SO, Breinholt JP, Cardarelli M, Penk JS, Novick WM. (2019) Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre. Cardiology in the Young29: 363–368. doi: 10.1017/S1047951118002457

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