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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 ,
Frank J. Molloy Open the ORCID record for Frank J. Molloy [Opens in a new window] ,
Christian L. Gilbert ,
Mark Danton ,
Ali Dodge-Khatami ,
Sri O. Rao ,
John P. Breinholt ,
Marcelo Cardarelli ,
Jamie S. Penk  and
William M. Novick
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
*
Author for correspondence: William M. Novick, MD, William Novick Global Cardiac Alliance, University of Tennessee Health Science Center, Memphis, TN, USA. Tel: +1 901 438 9413; E-mail: bill.novick@cardiac-alliance.org
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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.

Keywords

CHDinternational assistanceoutcomes
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 363 - 368
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

References

1. Hoffman, JI. The global burden of congenital heart disease. Cardiovasc J Africa 2013; 24: 141–145.Google Scholar
2. Borst, HG. The hammer, the sickle, and the scalpel: a cardiac surgeon’s view of eastern Europe. Ann Thorac Surg 2000; 69: 1655–1662.Google Scholar
3. Wallen, TJ, Arnaoutakis, GJ, Blenden, R, Soto, R. Programmatic changes to reduce mortality and morbidity in humanitarian congenital cardiac surgery. World J Pediatr Congenit Heart Surg 2018; 9: 47–53.Google Scholar
4. Novick, WM, Stidham, GL, Karl, TR, et al. Paediatric cardiac assistance in developing and transitional countries: the impact of a fourteen year effort. Cardiol Young. 2008; 18: 316–323.Google Scholar
5. Fenton, KN, Castillo, SH, Claro, CD, Novick, WM. Teamwork and program organization in developing countries. World J Pediatr Congenit Heart Surg 2011; 2: 219–224.Google Scholar
6. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.Google Scholar
7. Catchpole, KR, de Leval, MR, McEwan, A, et al. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Paediatr Anaesth. 2007; 17: 470–478.Google Scholar
8. Balachandran, R, Kappanayil, M, Sen, AC, et al. Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: a single center experience in a developing economy. Ann Card Anaesth 2015; 18: 52–57.Google Scholar
9. Jenkins, KJ, Castañeda, AR, Cherian, KM, et al. Reducing mortality and infections after congenital heart surgery in the developing world. Pediatrics 2014; 134: e1422–e1430.Google Scholar
10. Neirotti, R. Paediatric cardiac surgery in less privileged parts of the world. Cardiol Young 2004; 14: 341–346.Google Scholar
11. Pasquali, SK, He, X, Jacobs, JP, et al. Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS congenital heart surgery database. Ann Thorac Surg 2012; 94: 573–579.Google Scholar
12. ECHSA Congenital Database. Accessed on December 10, 2016.Google Scholar
13. The Society of Thoracic Surgeons Congenital Heart Surgery Database 2016 Congenital Report Executive Summary. Available at http://www.sts.org/national-database/database-managers/executive-summaries. Accessed on May 9, 2017.Google Scholar
14. Welke, KF, Diggs, BS, Karamlou, T, et al. Comparison of pediatric cardiac surgical mortality rates from national administrative data to contemporary clinical standards. Ann Thorac Surg 2009; 87: 216–223.Google Scholar
15. Congenital Heart Disease Statistics 2003. Available at https://www.bhf.org.uk/publications/statistics/congenital-heart-disease-2003. Accessed on April 1, 2017.Google Scholar
16. Brown, KL, Crowe, S, Franklin, R, et al. Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010. Open Heart 2015; 2: e000157.Google Scholar
17. Kogon, B, Karamlou, T, Baumgartner, W, et al. Congenital cardiac surgery fellowship training: a status update. J Thorac Cardiovasc Surg 2016; 151: 1488–1495.Google Scholar
18. Fraser, CB. Becoming a congenital heart surgeon in the current era: realistic expectations. J Thorac Cardiovasc Surg 2016; 151: 1496–1497.Google Scholar
19. Baliulis, G, Lipnevicius, A, Sudikiene, R, et al. Sustainable knowledge transfer in pediatric cardiac surgery: a team approach to shared learning. World J Pediatr Congenit Heart Surg 2011; 2: 225–230.Google Scholar
20. Armsby, L, Beekman, RH 3rd, Benson, L, et al. SCAI expert consensus statement for advanced training programs in pediatric and congenital interventional cardiac catheterization. Catheter Cardiovasc Interv 2014; 84: 779–784.Google Scholar
21. Jonas, RA. Congenital heart surgery in developing countries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2008; 11: 3–6.Google Scholar