Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-06-09T09:07:57.886Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  18 April 2016

Gabriele M. Iacona ,
Alessandro Giamberti ,
Raul F. Abella ,
Giuseppe Pomè ,
Julio Agredo ,
Saúl G. Mendieta ,
Antonio Forcano ,
Concepción Sobrado ,
Josepha Suaréz  and
Sonia Peñate
...Show all authors
Gabriele M. Iacona*
Affiliation:
Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut, United States of America
Alessandro Giamberti
Affiliation:
Division of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
Raul F. Abella
Affiliation:
Congenital Cardiac Surgery Service, Vall d’Hebron General Hospital, Barcelona, Spain
Giuseppe Pomè
Affiliation:
Division of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
Julio Agredo
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Saúl G. Mendieta
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Antonio Forcano
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Concepción Sobrado
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Josepha Suaréz
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Sonia Peñate
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Asunción Melián
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Montserrat Volo
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Rafael González
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Marisa L. Antúnez
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Hipólito L. Falcón
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Francisco J. Cabrera
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Carlos Rubio
Affiliation:
Paediatric Cardiology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
Javier Fernández
Affiliation:
Paediatric Cardiology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
Pedro Suárez
Affiliation:
Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
Cesar Perera
Affiliation:
Paediatric Cardiology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
Alessandro Frigiola
Affiliation:
Division of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Paediatric cardiac surgeryregionalisation of careoutcomesAristotle score
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 273 - 283
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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: 35–43.Google Scholar
2. Chang, RK, Klitzner, TS. Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 2002; 109: 173–181.CrossRefGoogle ScholarPubMed
3. Section on Cardiology, Cardiac Surgery and American Academy of Pediatrics. Guidelines for pediatric cardiovascular centers. Pediatrics 2002; 109: 544–549.CrossRefGoogle Scholar
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: 343–351.CrossRefGoogle ScholarPubMed
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: 911–924.Google Scholar
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: 251–254.CrossRefGoogle ScholarPubMed
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.Google Scholar
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: 287–289.Google Scholar
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 Google Scholar
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.Google Scholar
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: 1133–1140.Google Scholar
12. Chang, RK, Klitzner, TS. Resources, use, and regionalization of pediatric cardiac services. Curr Opin Cardiol 2003; 18: 98–101.CrossRefGoogle ScholarPubMed
13. Lundstrom, NR, Berggren, H, Bjorkhem, G, Jogi, P, Sunnegardh, J. Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol 2000; 21: 353–357.CrossRefGoogle ScholarPubMed
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: 380–384.Google Scholar
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: 229–238.Google Scholar
16. Finlayson, SR, Birkmeyer, JD, Tosteson, AN, Nease, RF Jr. Patient preferences for location of care: implications for regionalization. Med Care 1999; 37: 204–209.Google Scholar
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: 877–882.Google ScholarPubMed
18. Instituto Canario de Estadistica, Las Palmas de Gran Canaria. Retrieved 21 March 2013 from http://www.gobiernodecanarias.org/istac/jaxi-istac/tabla.do?uripx=urn:uuid:7a0b6af5-e89f-42ed-8395-16477beac6a0&uripub=urn:uuid:77ff28fc-e8b2-4544-bcb6-433f2288abed Google Scholar
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: 419–428; discussion 428–430.Google Scholar
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: 139–144; discussion 145–136.CrossRefGoogle Scholar
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: 899–905.Google Scholar
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: 932–938.CrossRefGoogle ScholarPubMed
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: 2117–2127.Google Scholar
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: 248–255.Google Scholar