Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 107

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 AFRICA 105
list to Go) to enter all procedures and related complications. Data
were analysed over five years, the last two years encompassing
changes in surgical and peri-operative practice aimed at facilitat-
ing early extubation and decreasing ICU and hospital length of stay
(LOS).
Results: Complication rates were expressed as total number per 10
OHS, and rates were summarised quarterly with 95% confidence
limits (CI). In the past two years, complications have decreased
significantly from 5.2 (CI 4.6–5.8) per 10 procedures to 3.0 (CI
2.4–3.6) per 10 procedures (p < 0.0001). The rate in each era has
remained stable and, despite an increase in case complexity in the
recent era, the ICU (6.3 vs 2.6 days, p < 0.0001) and hospital LOS
(12.6 vs 6.2 days, p < 0.0001) have decreased.
Conclusions: Implementation of new strategies for reducing patient
morbidity, ICU and hospital LOS has been successful. Control charts
with quarterly rates for all complications were readily derived, and
these allow estimation of current morbidity trends. The effect of QA
processes can be assessed in a timely manner.
772: BEATING THE ODDS: AN ORIGINAL ADVENTURE IN
FAVOUR OF MEXICAN CHILDREN WITH CONGENITAL
HEART DISEASE
Almudena March, Alexis Palacios-Macedo
Congenital Heart Surgery Division, Instituto Nacional de Pediatria,
Mexico
Mexico has a total population of 112 336 538, a growing population
index of 1.40, and every year 21 151 babies are born with congenital
heart disease, our second cause of child mortality before the age of
five. We have 10 public hospitals that can perform paediatric heart
surgery but with more than 50 million people living in poverty, all
the public hospitals are overcrowded, with not enough infrastructure
or human resources to give appropriate attention to our heart patients.
An estimation of the number of annual surgeries that are performed
on paediatric patients per year in public and private hospitals hardly
reaches 25% of the children that are at risk. Some children are born
into a family that can pay for medical attention in a private hospital,
but the majority of Mexicans have no medical cover or social secu-
rity. These families need our help the most.
We face a serious health problem that is difficult to change. On
one hand we have public hospitals that have many heart patients who
cannot pay for private medical attention, or, because of the large
number of cases treated, cannot be cared for by best heart specialists.
On the other hand, private hospitals have money to spend but few
cases to work on, and do not support the huge investments required
for medical equipment, human resources and training. We decided
to transform this situation, joining three groups together: a private
hospital, a government-funded paediatric hospital and a founda-
tion dedicated to the medical care of children with congenital heart
disease. We share our strategy, programme, and how we have started
to make it work.
888: CAN A COMPREHENSIVE CONGENITAL HEART
PROGRAMME BE DEVELOPED IN RUSSIA WITH LIMIT-
ED RESOURCES AND MAINTAIN QUALITY OUTCOMES?
Janet Simsic1, Frank Cetta2 , Josie Everett3 , Natasha Lusin3, Stuart
Berger4, Nathaniel Taggart2 , Gary Raff5 , Anton Avramenko6, Evgeny
Krivochekov7, Nilas Young 5
1Cardiology, Nationwide Children’s Hospital, Columbus, OH, USA
2Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
3Heart-to-Heart International Children’s Medical Alliance, Oakland,
CA, USA
4Cardiology, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
5Cardiothoracic Surgery, University of California, Davis Children’s
Hospital, Sacramento, USA
6Cardiothoracic Surgery, Cardiology Institute, Samara, Russia
7Cardiothoracic Surgery, Institute of Cardiology, Tomsk, Russia
Background: Worldwide, less than 15% of children born with
congenital heart disease have access to appropriate medical care. The
purpose of this study was to evaluate the effectiveness of the Heart-
to-Heart International Children’s Medical Alliance’s multidisciplinary
training programme to improve the care of children with congenital
heart disease in Russia by creating sustainable centres of excellence.
Methods: The process begins with site assessment encompassing
evaluation of medical, administrative, governmental support and
desire for the programme. It is followed by a multi-year commitment
to the US–Russian training programme consisting of: (1) strategic
guidance and team building: year-round guidance on programme
development, and specific recommendations for the ‘next steps’. (2)
Data collection and analysis: to provide detailed feedback to improve
results. (3) Annual surgical educational missions: the Heart-to-
Heart team works side by side with Russian colleagues to diagnose,
perform cardiac surgery and catheterisation, and provide post-opera-
tive care. (4) Scholar exchange: Russian physicians travel to centres
of excellence in the USA or Russia, and attend international confer-
ences. (5) Continuing education: professional educational materials,
participation in US journal clubs, and attending medical conferences.
Results: Composite outcome data from two centres (Samara and
Tomsk) are presented. Over a five-year time frame, the total number
of cardiac operations increased from the baseline 186 in year one
to 514 in year five; the complexity of cases RACHS 3–6 increased
from 11.5 to 26.5%; children less than 12 months of age at the time
of surgery increased from 21 to 46%; mortality decreased from 14 to
4%. The median cash expenditure per site per year was 99 612 USD
(range 73 977–182 030 USD).
Conclusions: The goal of creating a comprehensive, sustainable
programme to care for children with congenital heart disease can
be accomplished in a fairly short period of time with modest finan-
cial investment. The individualised, multidisciplinary training and
educational strategy developed by Heart-to-Heart International
Children’s Medical Alliance has proven successful in increasing
patient complexity over time, with excellent surgical results.
946: SAVE A CHILD’S HEART: 17 YEARS OF ACTIVITY
Lior Sasson1,2, Sion Houri1,2, Alona Raucher Sternfeld1,2, Ilan Cohen1,2,
Livia Kapusta1,2, Godwin Sharau1,2,3, Omar Assali1,4, Omar Suleiman1,5,
Simon Fisher1, Akiva Tamir1,2
1Save a Child’s Heart, Israel
2Edith Wolfson Medical Centre, Israel
3Bugando Medical Centre, Tanzania
4Rafidia Hospital, West Bank, Palestine
5Mnazi Mmoja Hospital, Zanzibar
Save a Child’s Heart (SACH) is a hospital-based, non-governmental
organisation founded by Dr Ami Cohen in 1994 at the Wolfson
Medical Centre in Israel. Its goal is to improve the cardiac care
of children with heart diseases from developing countries. This is
achieved through two main channels: (1) treating children with heart
disease through surgery and/or cardiac catheterisation in Israel, and
(2) training medical personnel from partner countries. Over 2 900
children have been treated so far and over 70 physicians and nurses
have been trained. The main mode of action is by direct cooperation
with a medical facility trying to help their patients.
Fifty per cent of our patients are Palestinians, referred by their
local physicians to our free clinic for further treatment. With regard
to children from our overseas partner countries, we travel to the
country to screen patients, discuss their problems with the local team
and the child is wait-listed to be brought to the SACH centre in Israel.
In addition, we offer training positions in an attempt to build a local
team who will treat their own patients. As a part of this endeavour,
we also go on surgical missions to the partner country and operate
together with the local team. Individual patients who contact us via
different channels are also accepted according to feasibility of treat-
ment. The presentation will describe our activity during the past 17
years, the structure of the organisation, mode of action, problems and
achievements.