PEDIATRIC CARDIOVASCULAR SURGERY SERVICE. Referral Center for Pediatric Cardiovascular Surgery

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1 PEDIATRIC CARDIOVASCULAR SURGERY SERVICE Referral Center for Pediatric Cardiovascular Surgery

2 INTRODUCTION Each year 133 million children are born worldwide from a population of 6.6 billion people; one million of these newborn babies suffer some type of congenital cardiac anomaly. Ninety percent of these children are born in developing countries, leaving most of them with no chance of treatment of their disease. South America does not escape from this situation; from 7.5 million children born annually, and one million in Colombia, around 1% ( children) is born with congenital heart disease; 70% of them require some sort of treatment involving surgery or interventionism. Fundación Cardioinfantil - Instituto de Cardiología (FCI -IC), shares its mission and vision with a select group of institutions throughout the world, whose main objective is to help save the lives of children with heart disease. In the words of the World Society for Pediatric and Congenital Heart Surgery: Every newborn child with congenital heart disease anywhere on the planet must have access to appropriate medical and surgical treatment. Dr. Néstor Sandoval Reyes Head of Pediatric Cardiovascular Surgery

3 Annually more than children born in South America unfortunately do not get any option of treatment for their cardiopathies. The Social Programme of FCi-IC Give a Life travels through all Colombia doing pediatric cardiovascular brigades to find children under 18, who suffer from heart diseases and have limited economical resources, for give them the opportunity of being diagnosed and treated without any payment at our institution After 38 years of the institution s foundation, children mainly from low economic substrate have been treated and returned to a healthy life thanks to individuals and companies donors from Colombia and other countries that support the Give a Life program. FCI-IC is a Referal Centre in Paediatric Cardiovascular Surgery committed to offer the best medical, scientific, human and technological care to all the pediatric patients from all social classes. HEARTS SMILE AGAIN

4 FCI-IC s Pediatric Cardiovascular Surgery Service is pioneer and leader in Colombia in high complexity surgery, neonatal surgery, management of cardiopathy with pulmonary hypertension, cardiac arrhythmias, valve repair, univentricular heart, selective cerebral perfusion techniques for aortic arch repairs, ultrafiltration methods, hybrid procedures, adult congenital cardiopathy and reoperation. Each year, the number of patients submitted from other institutions and neighbour countries increases. On 2011 the cardiac failure and pediatric heart transplant service was implemented. PEDIATRIC CARDIOVASCULAR SURGERY REFERENCE CENTER

5 Congenital Surgeries FCI-IC The average number of congenital surgeries at the institution is 455 per year, making the FCI-IC a Referral Center in Congenital Cardiopathy Surgery Average Relation of national vs. international patients. % National International Since 2003, patients from other countries in the American continent, Antilles and Africa have been attended. By year 2010 the percentage of international patients which had been attended reached 4.3% of the total number of operated patients

6 INTERNATIONAL QUALITY STANDARDS The FCI-IC s Pediatric Cardiovascular Surgery Service as a Pediatric Cardiovascular Surgery Referral Center in Colombia is amongst the most important centres in South America because of its volume and high complexity surgeries. Due to the rigorous and permanent epidemiological monitoring, the institution has reached international quality standards such as those of the Society of Thoracic Surgeons (STS), Pediatric Cardiac Care Consortium PCCC, European Association for Cardiothoracic Surgery (EACTS). A monitoring of the principal quality indicators such as: volume, mortality, infection, cardiac and non-cardiac complications and attention opportunity is also performed constantly. We work for a common goal, save the hearts of Colombian children as well as those of children from neighbouring countries; for this purpose we have assembled a multidisciplinary team made up of pediatric cardiologists and cardiovascular surgeons, cardiovascular anaesthesiologists, pediatric perfusionists, intensive care pediatricians, and specialized nurses. In addition, the emotional support from parents and relatives of children who have undergone surgery is fundamental for their recovery as well as an excellent complement to the treatment. Mortality percentage according to risk category RACHS-1 and by year in comparison to the American and European societies of cardiac surgery. RACHS-1 FCI 2009 FCI 2010 STS (1) PCCC (2) EJCTS (3) RACHS RACHS RACHS RACHS TOTAL The mortality risk in pediatric cardiovascular surgery may be analysed in different ways and with different categories. We implemented the RACHS1 in which the complexity is evaluated in ascending form from 1 to 6. The most common surgeries and with the smallest death risk belong to the categories 1, 2 and 3, and the less frequent ones, which have a higher risk belong to categories 4, 5 and Jacobs JP, Jacobs ML, Lacour-Gayet FG et al. Stratification of complexity improves the utility and accuracy of outcomes analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. Pediatr Cardiol Nov;30(8): Jenkins ( PCCC) J Thorac Cardiovasc Surg 2002;123: Boetig D y Cols. Eur J Cardiothorac Surg Jul;26(1):12-7

7 GENERAL RESULTS Most frequently performed procedures. Percutaneous vs. Open surgical procedures by year Surgical procedures Percutaneous procedures MUSTARD TRUNCUS ARTERIOSUS VASCULAR RING EBTEIN HLHS RV AP CONDUIT INTERRUPTED AORTIC ARCH PACEMAKER PARCIAL AV CANAL FONTAN SUBAORTIC MEMBRANE AORTIC VALVE SURGERY PAPVC DORV MITRAL VALVE SURGERY ARTERIAL SWITCH TAPVC BIDIRECCIONAL GLENN COMPLETE AV CANAL PULMONARY BANDING TETRALOGY OF FALLOT SISTEMIC PULMONARY SHUNT COARTATION OF THE AORTA PDA ATRIAL SEPTAL DEFECT VENTRICULAR SEPTAL DEFECT The ratio of surgical procedures to Interventional procedures in hemodynamics is 2:1.

8 Global mortality tendency. % of mortality Patients who had undergone surgery by age group. 250 Number of Patients Newborn 15.2% 1 month - 12 months 33.7% > 1 year 51.1% At the FCI IC, 50% of children undergoing open heart surgery are under 1 year of age, which is in keeping with numbers reported by top international referral centers.

9 Our medical personnel are highly experienced in congenital and acquired pediatric cardiovascular surgery, and stay atop the latest developments in their respective areas, through continuous medical education programs in the best national and international centers, and are active members in multiple scientific societies such as the Colombian Society of Cardiology and Cardiovascular Surgery, Society of Thoracic Surgeons (STS), World Society for Pediatric and Congenital Heart Surgery (WSPCHS), Latin Society for Cardiovascular and Thoracic Surgery, Latin Society for Cardiology and Pediatric Cardiovascular Surgery. COMPLEX CASES WITH POSITIVE RESULTS At the FCI-IC, cardiac surgery on newborns are performed more and more frequently. Consequently, we see more complex diseases which weren t diagnosed before or treated in an appropriate manner. An example of the aforementioned is the anomaly denominated Persistent Truncus Arteriosus associated with the interruption of the aortic arch. Its correction is a complex procedure which in many institutions which belong to the Society of Thoracic Surgeons (STS) has a mortality rate around 27%. At the FCI-IC 3 patients with this pathology have undergone complete repair over the last 4 years without deaths in the first 30 days, survival to the present date of 100% and with an excellent functional state. 1- Eur J Cardiothorac Surg Jul;38(1): Ann Thorac Surg 2006;81:214 23

10 PEDIATRIC CARDIOVASCULAR INTENSIVE CARE UNIT The pediatric cardiovascular ICU (Intensive Care Unit) has 12 fully equipped beds with state-of-the-art technology for support such as high frequency ventilators, helium ventilation, central pressure monitoring, saturation, register and constant electrocardiogram recording, non-invasive mechanical ventilation, nitric oxide, installations for the ECMO (Extracorporeal Membrane Oxigenator) and isolation for special patients. These 12 beds, as well as the 24 neonatal ICU beds are staffed with an intensivist and pediatric cardiologist 24 hours per day. All unit nursing personnel have a graduate degree in pediatrics and 30% have performed cardiovascular training in foreign countries.

11 HUMAN SCIENTIFIC TEAM Pediatric Cardiovascular Surgery Dr. Néstor Sandoval Reyes Head of Pediatric Cardiovascular Surgery Service Dr. Renato Bresciani Buitrago Pediatric Cardiovascular Surgeon

12 Pediatric Cardiology and Interventional Cardiology Dr. Miguel Ronderos Pediatric Cardiology Interventionist Dr. Alberto García Pediatric Cardiology Interventionist Dra. Claudia Stapper Pediatric Cardiologist Transesophageal Echocardiography Dr. Manuel Huertas Pediatric Cardiologist Dr. Álvaro Arenas Pediatric Electrophysiologist Pediatric Intensive Care Unit Dra. Martha Reyes Head of Pediatric Intensive Care Unit Dr. Alberto Guerra Pediatric Intensivist

13 MEDICAL SCIENTIFIC SOCIETIES The FCI-IC s Pediatric Cardiovascular Surgery Service has a direct link with the World Society for Pediatric and Congenital Heart Surgery through Dr. Néstor Sandoval, member at the society s Governing Council board as representative for South America, and member of the editorial council of its official magazine World Journal for Pediatric and Congenital Heart Surgery, whose main interest is the congregation, scientific and academic support to every person, institution and world centre for the improvement in the care of children with heart diseases.

14 ACCREDITATIONS Our experience, technology, procedures, accreditation, training for specialists, results comparable to the best centers in the latin America, North America and Europe Our institution has been a three times winner of the Health Quality Award in Colombia and obtained the Health accreditation given by ICONTEC and the Government through the Ministry of Health within the Unique System of Health Accreditation which is part of the Obligatory System for Quality and Guarantee. The Accreditation in Health in Colombia is considered as valid throughout the whole world, as the International Society for Quality in Health Care, ISQua, approved the International Accreditation for ICONTEC s Health Accreditation System for a 4 year period. A Chinese proverb says: You may be able to get two or more people to sleep on the same bed, but it is impossible to get them to dream the same dream. The success of the Fundación Cardioinfantil Instituto de Cardiología is to have managed to make all who work here dream the same dream. The heart of children in Colombia. Reinaldo Cabrera Polanía ( ) Founder Fundación Cardioinfantil Instituto de Cardiología

15 PEDIATRIC CARDIOVASCULAR SURGERY SERVICE Coordinator Vanesa Romero NR +(57) Land-Line Telephone +(571) PBX +(571) extensions 1308 and hours Mobile phone +(57) (international patients) Address Calle 163 A # 13B-60 Bogotá, Colombia. Every time you use the Children s Heart Foundation Institute of Cardiology s services, you will be helping us to save the lives of children with limited resources who suffer from heart diseases.