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Paediatric cardiac surgery in a peripheral European region: is a joint programme a safe alternative to regionalisation?

  • Gabriele M. Iacona (a1), Alessandro Giamberti (a2), Raul F. Abella (a3), Giuseppe Pomè (a2), Julio Agredo (a4), Saúl G. Mendieta (a4), Antonio Forcano (a4), Concepción Sobrado (a4), Josepha Suaréz (a4), Sonia Peñate (a4), Asunción Melián (a4), Montserrat Volo (a4), Rafael González (a4), Marisa L. Antúnez (a4), Hipólito L. Falcón (a4), Francisco J. Cabrera (a4), Carlos Rubio (a5), Javier Fernández (a5), Pedro Suárez (a4), Cesar Perera (a5) and Alessandro Frigiola (a2)...

Abstract

Background

In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands.

Methods

An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated.

Results

In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients).

Conclusions

A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.

Copyright

Corresponding author

Correspondence to: G. M. Iacona, Yale University School of Medicine, Yale New Haven Hospital, 330 Cedar Street, Boardman 204, New Haven, CT 06520, United States of America. Tel: +12037857627; Fax: +12037853346; E-mail: gabriele.iacona@yale.edu

References

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1. Dearani, AJ, Neirotti, R, Kohnke, EJ, et al. Improving pediatric cardiac surgical care in developing countries: matching resources to needs. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2010; 13: 3543.
2. Chang, RK, Klitzner, TS. Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 2002; 109: 173181.
3. Section on Cardiology, Cardiac Surgery and American Academy of Pediatrics. Guidelines for pediatric cardiovascular centers. Pediatrics 2002; 109: 544549.
4. Daenen, W, Lacour-Gayet, F, Aberg, T, et al. Optimal structure of a congenital heart surgery department in Europe. Eur J Cardiothorac Surg 2003; 24: 343351.
5. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911924.
6. Iacona, GM, Giamberti, A, Abella, RF, et al. Fontan operation for patient with complex anatomy: the intra-atrial conduit technique. World J Pediatr Congenit Heart Surg 2012; 3: 251254.
7. Iacona, GM, Giamberti, A. Reply to “a slight modification of the intra-atrial conduit Fontan procedure” by Dr F. Fantini. World J Pediatr Congenit Heart Surg 2013; 4: 234.
8. Iacona, GM, Barber, M, Medina, M, et al. Intrapericardial teratoma in a low birth weight infant: a successful multidisciplinary approach. Interact Cardiovasc Thorac Surg 2011; 12: 287289.
9. Population and Housing Census 2011, National, autonomic and provincial results Spain. National Statistics Institute, Las Palmas de Gran Canaria. Retrieved 20 March 2013 from http://www.ine.es/jaxi/menu.do?type=pcaxis&path=/t20/e244/avance/p01/&file=pcaxis
10. Asistencia integral del neonato con cardiopatía congénita y del niño con cardiopatía congénita compleja (aristóteles 3). Criterios, acordados por el consejo interterritorial, que deben cumplir los CSUR. Grupo de expertos de Cardiología y Cirugía cardiaca, Ministerio de Sanidad, Servicios Sociales, e Igualdad, Madrid, Spain. Retrieved 31 January 2013 from http://www.msssi.gob.es/profesionales/centrosdereferencia/docs/fesp/ fesp32.pdf.
11. Welke, KF, O’Brien, SM, Peterson, ED, Ungerleider, RM, Jacobs, ML, Jacobs, JP. The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database. J Thorac Cardiovasc Surg 2009; 137: 11331140.
12. Chang, RK, Klitzner, TS. Resources, use, and regionalization of pediatric cardiac services. Curr Opin Cardiol 2003; 18: 98101.
13. Lundstrom, NR, Berggren, H, Bjorkhem, G, Jogi, P, Sunnegardh, J. Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol 2000; 21: 353357.
14. Hellstrom-Westas, L, Hanseus, K, Jogi, P, Lundstrom, NR, Svenningsen, N. Long-distance transports of newborn infants with congenital heart disease. Pediatr Cardiol 2001; 22: 380384.
15. Pinto, NM, Lasa, J, Dominguez, TE, Wernovsky, G, Tabbutt, S, Cohen, MS. Regionalization in neonatal congenital heart surgery: the impact of distance on outcome after discharge. Pediatr Cardiol 2012; 33: 229238.
16. Finlayson, SR, Birkmeyer, JD, Tosteson, AN, Nease, RF Jr. Patient preferences for location of care: implications for regionalization. Med Care 1999; 37: 204209.
17. Chang, RK, Joyce, JJ, Castillo, J, Ceja, J, Quan, P, Klitzner, TS. Parental preference regarding hospitals for children undergoing surgery: a trade-off between travel distance and potential outcome improvement. Can J Cardiol 2004; 20: 877882.
19. Sollano, JA, Gelijns, AC, Moskowitz, AJ, et al. Volume-outcome relationships in cardiovascular operations: New York State, 1990–1995. J Thorac Cardiovasc Surg 1999; 117: 419428; discussion 428–430.
20. Welke, KF, Karamlou, T, Ungerleider, RM, Diggs, BS. Mortality rate is not a valid indicator of quality differences between pediatric cardiac surgical programs. Ann Thorac Surg 2010; 89: 139144; discussion 145–136.
21. Kalfa, D, Chai, P, Bacha, E. Surgical volume-to-outcome relationship and monitoring of technical performance in pediatric cardiac surgery. Pediatr Cardiol 2014; 35: 899905.
22. Pasquali, SK, He, X, Jacobs, JP, et al. Measuring hospital performance in congenital heart surgery: administrative versus clinical registry data. Ann Thorac Surg 2015; 99: 932938.
23. Birkmeyer, JD, Stukel, TA, Siewers, AE, Goodney, PP, Wennberg, DE, Lucas, FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349: 21172127.
24. Nguyen, N, Jacobs, JP, Dearani, JA, et al. Survey of nongovernmental organizations providing pediatric cardiovascular care in low- and middle-income countries. World J Pediatr Congenit Heart Surg 2014; 5: 248255.

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Paediatric cardiac surgery in a peripheral European region: is a joint programme a safe alternative to regionalisation?

  • Gabriele M. Iacona (a1), Alessandro Giamberti (a2), Raul F. Abella (a3), Giuseppe Pomè (a2), Julio Agredo (a4), Saúl G. Mendieta (a4), Antonio Forcano (a4), Concepción Sobrado (a4), Josepha Suaréz (a4), Sonia Peñate (a4), Asunción Melián (a4), Montserrat Volo (a4), Rafael González (a4), Marisa L. Antúnez (a4), Hipólito L. Falcón (a4), Francisco J. Cabrera (a4), Carlos Rubio (a5), Javier Fernández (a5), Pedro Suárez (a4), Cesar Perera (a5) and Alessandro Frigiola (a2)...

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