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

Autor:	Polivenok IV; 1Zaitcev Institute for General and Urgent Surgery,Kharkiv,Ukraine., Molloy FJ; 2William Novick Global Cardiac Alliance,Memphis,TN,USA., Gilbert CL; 3Penn State Health,St Joseph's Hospital,Reading,PA,USA., Danton M; 4Royal Hospital for Sick Children,Glasgow,Scotland,UK., Dodge-Khatami A; 5Children's Heart Center,Jackson,MS,USA., Rao SO; 2William Novick Global Cardiac Alliance,Memphis,TN,USA., Breinholt JP; 6University of Texas Health Science Center at Houston,TX,USA., Cardarelli M; 2William Novick Global Cardiac Alliance,Memphis,TN,USA., Penk JS; 8Advocate Children's Hospital,Chicago,IL,USA., Novick WM; 2William Novick Global Cardiac Alliance,Memphis,TN,USA.
Jazyk:	angličtina
Zdroj:	Cardiology in the young [Cardiol Young] 2019 Mar; Vol. 29 (3), pp. 363-368. Date of Electronic Publication: 2019 Feb 28.
DOI:	10.1017/S1047951118002457
Abstrakt:	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 methodsThe 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.
Databáze:	MEDLINE
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