NEWSLETTER

October 1998

LETTER FROM THE PRESIDENT

Dear Friends

As one of the founder members of EACTS it has been a pleasure for me to see the steady growth of the Association and to witness its increasing influence at an International level in our Specialty. It is an honour and a privilege to be its thirteenth President.

The next meeting from 5th to 8th September 1999 will be in my home city, Glasgow. We are planning a high quality scientific meeting, in pleasing surroundings, together with social activities to make this a memorable meeting and a chance for delegates to share in the culture and attractions of yet another part of Europe.

In the United Kingdom at present there is great concern about standards of practice and professional competence. Government is rightly requiring demonstration of good clinical practice, and "clinical governance", "continuing medical education", "evidence-based medicine" and "revalidation or recertification of specialists", are high on the political agenda for medicine. We are not alone in this respect; other countries in Europe will be familiar with these pressures. EACTS is ideally placed to take a role in enabling surgeons to stay up-to-date and well informed, and our annual meeting activities should be a good beginning.

One of my goals as President is to enhance the educational role of EACTS. We already have an annual meeting rivalling the best North American meetings. The European Journal of Cardio-thoracic Surgery, our official journal, is one of the leading journals of our Specialty, and publishes most of the papers presented at the annual meeting. Breakfast sessions were commenced in 1991, and in 1994 postgraduate courses were introduced to run in association with our annual meeting. I will encourage these activities, and will emphasise their educational nature. They will be aimed at surgeons in training as well as all in established practice wishing a chance to refresh knowledge and keep up to date.

We have many capable and enthusiastic experts in Europe who will ensure the quality of these educational activities. However, we continue to rely on members submitting their best work for the meeting to achieve a successful scientific meeting.

Another goal of my Presidency is to establish the first fellowships within Europe for laboratory based research related to cardio-thoracic surgery. This represents an attempt to stimulate our most capable young surgeons to develop a life-long interest in academic activities, so essential for the continued scientific advance of our specialty. We will soon be advertising the first of these fellowship opportunities.

The notable presence of so many leaders in our specialty from North America at our meetings is evidence of the high regard in which EACTS is held there. Cooperation with The Society of Thoracic Surgeons and The American Association for Thoracic Surgery is already reflected in the ready availability of educational material through CTSNet. In addition, we are exploring the possibility of establishing exchange "fellowships" to allow trainees in Europe and North America to gain exposure to research or surgical practice on either side of the Atlantic.

Through my long association with EACTS I have been highly impressed by the professional talent and ingenuity of my surgical colleagues, and the diversity and cultural richness of Europe. I intend to do my best to foster these assets and look forward to a productive year as your President.

David Wheatley, M.D.
President

From the Secretary General

I have just returned from Brussels, from the magnificent Annual Meeting that Paul Sergeant and his Local Organising Committee arranged. On behalf of the Council and indeed all participants, I would like to thank the Local Organising Committee for their great contribution in arranging the meeting.

I think the meeting will be remembered for its high scientific content, good organisation but above all, perhaps, for its friendly and happy mood, a mood which was set by the EACTS dixieland orchestra including Jean-Marie Wihlm and John Cockburn during the opening reception.

Our President, Eugene Baudet, gave his presidential address Cardiac Surgery in the 21st Century. The Future is now. The Honoured Guest lecture was given by Floyd D. Loop on the subject of Coronary Artery Surgery. The End of the Beginning. These talks will be published in our Journal. Be sure to read them! The Science Lecture by Serge C. Renaud was entitled Dietary Prevention of Cardiovascular Disease, an extremely interesting overview of the attempts that have been made in order to elucidate the causes and prevention of coronary sclerosis. One of the conclusions I could make was that the epidemiology of coronary heart disease is possible to influence and that we should not educate too many cardiac surgeons.

Development of the Association

The development of the Association may be described in the following graphs. The Association has grown considerably during the last years. Membership has increased with the Membership Committee making a magnificent work this year in attracting 125 new members who were voted in during the General Assembly. Welcome all new members to the Association, welcome!

Number of members

The attendance at the Annual Meeting also has grown over the years thanks to the work of all Local Organising Committees and to the principle adopted by the Association to take advantage of the experience of all previous meetings, i.e. one of constant improvement, the way a knowledge organisation should develop. The task of being the continuity keepers and constant improvers lies with the Council but also with Maud Zingmark and with our Executive Secretariat, CASIL.

Number of attendees

Another sign of development is the number of abstracts sent in for consideration to the Annual Meeting. This year we had a record number of 903 abstracts out of which 211 were selected for presentation. The comments of the scientific value of these abstracts were very favourable during the meeting. The Programme Committees have over the years worked with diligence and integrity and great success with this very difficult task. As I every year get questions about the selection process, it will be outlined below.

Abstract Submission & Acceptance

Finally, what about our financial back-bone, the exhibition? The number of square meters being sold during the Annual Meeting also has increased due to the efforts of all involved in the marketing process, especially CASIL.

Economy

The Treasurer for the first time in the history of EACTS had to give a negative financial report. The net loss during the year was £343,003. These are the main explaining factors:

* Gross income from the Annual Meeting increased in comparison with previous years, however,

* Gross expenditure during the Annual Meeting increased markedly, mainly due to the tax and labour cost situations prevailing in Denmark. Thus the Annual Meeting did not give the usual surplus which normally is fed into and nourishes the Association activities outside the Annual Meeting.

Association costs increased due to two factors:

* One time expenses (i.e. expenses of one time occurrence in contrast to yearly costs) increased because of investments in the future thought necessary (Symposium for the Future, Management Course, European Board of Cardiovascular and Thoracic Surgeons, extra journal pages etc).

* Added yearly expenses: Committee costs. The new Committee structure, although very cheap in its function, nevertheless carries its costs. The expanded function of both editorial and secretary general's offices, as well as the rewards that the Association now has instigated, and the activities of the East European Committee also carry an added financial burden.

As the Association would not be able to absorb such a loss for several years, a programme of income increase and cost reduction has been introduced. This programme will have to include all aspects of the life of the Association and the routines during the Annual Meeting. Among the measures that we will have to take is the conduction of necessary meetings via Internet, travel by lowest air fare, decreased costs of for instance congress bags, decreased scope of social programme etc. We will also have to be very selective in the choice of future sites for the Annual Meeting.

How can you help?

I believe that the financial measures described will be enough to eventually rectify the situation. As we increased the membership fee relatively recently the Council at the moment has no plans of asking the members to increase their financial contribution. If necessary, that decision will have to be taken during the next General Assembly. However, we do ask you to help the Association by soliciting members, sending in your abstracts, publishing your scientific material in the Journal, coming to the Annual Meeting and sending your colleagues to our Meeting, i.e. be a keen ambassador of the Association in your sphere of influence.

General Assembly

The following nominees for vacant posts were approved by the General Assembly:

David Wheatley President
Joachim Hasse Vice President
Marko Turina as Editor, Marcos Murtra as Treasurer, and Torkel Åberg as Secretary General were re-elected to their posts.

I would like to express my personal gratitude to you all for your confidence in me as your Secretary General. I now enter my third term. As you know, the Constitution stipulates three officers to carry the continuity burden. The Editor is elected for a term of five years and can be re-elected once. The Secretary General and Treasurer are elected for three years and can be re-elected indefinitely.

Election of three councillors:
Deirdre Watson is a thoracic surgeon presently working in Norfolk, UK. She is also the Secretary of the Society of Cardiothoracic Surgeons of Great Britain & Ireland.
William Daenen, Leuven, Belgium, is a cardiac surgeon with a primary interest in congenital surgery.
Giuliano Maggi, Torino, Italy, specialises in general thoracic surgery and is the head of a large thoracic department.

Officers and Committees 1998/99

In conjunction with the Annual Meeting the terms of some officers and committee members expires. Replacers have been invited, but due to short notice before printing this Newsletter, they have not had time to respond. A full list will be announced in the next Newsletter.

Change of Constitution

During the General Assembly a change of constitution was voted upon in order to introduce Junior and International membership categories. The junior cardio-thoracic surgeons who previously have had no forum will now be able to join the Association

Junior membership

A surgeon early in his training and career can apply for junior membership and be accepted into the Association after the usual process. Junior membership can be held for a maximum of five years. After this period, the surgeon will have to decide whether to apply for full membership.

The rule stating that the junior membership lasts for five years makes the junior membership self-regulating. If the young surgeon enters junior membership "too early" in his career, then he will have to become an active member with its additional economic implications early. It is foreseen that the junior surgeon should be fully committed to cardio-thoracic surgery, shown by at least two year's experience in the field.

A Junior Committee will be formed. For the time being, until junior members have officially been voted in during the next General Assembly, a provisional Junior Committee under the chairmanship of Hans Huysmans has started to function with a meeting during the Brussels Meeting.

The advent into the Association of younger surgeons is going to vitalise the organisation. It will make the Association more representative of European Cardio-thoracic Surgery. The presence of young, eager minds in our various committees is going to make us more ready for the future, indeed will make us more suited to create the future. Take as an example the development in the IT area.

International membership

International membership was instigated in order to provide possibilities for oversees surgeons to become members and take part of the information system that the Association provides without taking on the responsibilities of an active member. A non-European surgeon can still -by his own choice- become an active member. When you travel around in the world, please bring some membership forms with you and try to solicit members. A copy of the new Membership Application form is attached with this Newsletter. Additional copies can be copied or required from the Executive Secretariat.

International Members pay an initiation fee of 33 ECU, and the annual dues are 198 ECU. Junior Members do not pay an initiation fee. The annual dues for Junior Members are ECU 50.

Journal to Junior Members

Lawrence H. Cohn, President of the AATS graciously announced a gift from the AATS, sponsored by St. Jude, which consisted of a free subscription of the Journal of Thoracic and Cardiovascular Surgery to European surgeons in training. Junior members will be provided with this gift.

CTSNet

The CTSNet (Cardiothoracic Surgery Network), http://www.ctsnet.org, is the site on the Internet where the large cardio-thoracic Associations have decided to collaborate. The initiative was taken by the STS under the presidency of Robert L. Replogle. As you have all had a chance to see, the development of the site has been fantastic. It is now the meeting point and excellent source of information for many of us and will become even more so.

The ownership and structure of the CTSNet is at present under deliberation. The STS wants to open up the ownership and influence to other international societies. Several interesting and fruitful discussions were held during the Brussels meeting between STS, EACTS and AATS.

The idea behind the CTSNet is to have one website for all cardio-thoracic surgeons. The CTSNet will be an international virtual home. There will be home sites for all associations wanting one (more or less for free), there will be an "Exhibition Hall" for you to see all the latest developments from the Industry, discussion forums for all kinds of clinical problems, etc., etc.

Other plans and ideas include a book store for relevant publications in our field, a publication site or virtual journal for that kind of publications which are specifically suited for the Internet, i.e. case reports, colour photographs, video illustrations, etc.; an information site about working conditions and visiting regulations for each country, job opportunity section, etc., etc.

For each site, there will be an editor with the responsibility of up-dating the factual material of the site. If you have an idea of a good area to develop, please contact me or Paul Sergeant. If you are willing to become an Editor, please do not hesitate to contact us.

When a cardio-thoracic surgeon has a problem related to his work, one of his own first reactions will in the future be to seek information on the CTSNet.

EJCTS Online

The full text issue of the European Journal of Cardio-thoracic Surgery is now available on the internet via the address: http://www.cardiosource.com. To access cardiosource you have to register in order to receive a password. We apologize for this inconvenience. However, the Association is putting much effort into transferring the EJCTS to the CTSNet and to have it linked to the homepage of the Association. We hope to accomplish this goal within the near future and will advertise it on the EACTS homepage when the transferral is completed,

Programme Committee process

The process in selecting the abstracts to be presented is as follows. Anonymous copies of abstracts are submitted to the EACTS Secretariat, i.e. authors and place of origin are not revealed. The abstracts of each category are then sent to special reviewers in the Programme Committee. (This means that not every Programme Committee Member reads every abstract at this stage). The abstracts are judged on a scale from 1 to 6 and the results compiled. The around 45% best abstracts are then sent to all Programme Committee members for a second review. The results of this second review are compiled. When the Programme Committee meets, the abstracts in each category are presented in a booklet in order of numerical merit, i.e. based upon the second round of judgements. The Programme Committee then in pleno selects the best abstracts in order to make an attractive programme. We usually start by dividing us up in smaller groups to make the programme for the thoracic and congenital as well as the major categories of the adult cardiac surgery, then present the suggestions for a united decision.

The principle is to go only for quality, no other considerations are taken (for instance geographical). A member of the Programme Committee does not judge an abstract coming from his own unit. Only at the very last hour of the Programme Committee meeting are the names of the authors disclosed when the full programme is presented via the computer.

The Programme Committee is very aware of the fact that its work will be scrutinised by all members. This is why the Association has instigated and is maintaining a fair, fully anonymous process, based on the quality of the abstract presented.

The European Cardiac Surgical Registry

The annual meeting was important and successful for ECSUR (European Cardiac Surgical Registry). Following a plenary session presentation by Kenneth Taylor and Richard Wyse, new software (Access 97) for the collection of the minimum adult cardiac surgery dataset was distributed free of charge to representatives of several hundred surgical centres. This software, with each disc specifically relating to each individual surgical centre, will help units record their surgical activity in a structured way, and will allow them to print simple reports to assist their own unit administration. It will also make it much easier for them to send their surgical data direct to ECSUR.

The ECSUR booth received a large number of visitors, both from Europe, and from many other centres throughout the world. Visitors not only collected their free software, but also learned that ECSUR is developing and assisting with similar international initiatives in thoracic surgery, and in paediatric cardiac surgery.

ECSUR is also under active discussions with members of The Society of Thoracic Surgeons of the USA (STS) to form agreement on the components of a more substantial adult cardiac surgical dataset, including risk factors, that can be used on a worldwide basis. The aim is for both the ECSUR minimum, and the larger International, datasets to be mutually compatible - allowing centres to select at which

level of sophistication they choose to contribute their surgical data. ECSUR is committed to producing and collecting unified, worldwide surgical datasets that will

allow centres more easily to benchmark themselves with current practices.

Council Meetings

The Council holds two meetings during the Annual Meeting, one before and one after. During these meetings it was among other things decided to institute an additional post in the Council of an Information Technology Officer with the responsibility of following the development of the modern communication media and to look into the future about the implications for us. This will need a change in the Constitution as announced during the General Assembly. For the time being, Paul Sergeant will be personally invited to the Council meetings.

Prizes and Awards

The 1996 Fontan Prize winner was Rimantas Benetis from Kaunas, Lithuania. During the scientific meeting he gave an interesting summary report of his experiences and training periods at the Hospital Broussais, Harefield Hospital, and at the University Hospital in Umeå. During the meeting the Fontan Prize winner for 1998 was announced. Paolo Masetti, Modena, Italy, was selected to further study "Venous dynamics in the chest and below the diaphragm in the conventional Fontan and extra cardiac connection". Congratulations and good luck with your work!

The Young Investigator's Awards were given to P. Brenner, Munich, for his excellent presentation within cardiac surgery. The presentation of R. Gasparri was awarded the thoracic prize. These mentioned grants were complemented by two Lillehei Young Investigator Awards generously donated by St. Jude Medical. The Lillehei Award winners were P. Herijgers, Leuven, Belgium, and P. Totaro, Brescia, Italy.

Management Course in Cardio-thoracic Surgery, 19-20 June 1999

After the highly successful Management Course in Mallorca in November 1997, the Council has decided to arrange a new Course, this time in Umeå, Sweden. It will be a two day course covering the following tentative topics:

The needs of the patient and of the personnel as a starting point in the management of a cardio-thoracic unit.
The changing attitude of lay people on health care and health care providers.
Quality assurance in cardio-thoracic surgery. Methods and possibilities.
Collaboration with the Industry. Advantages and pitfalls.
The use of multi-departmental and local registries in order to improve patient care.
The continuous education and self-improvement of a surgeon.
What determines the outcome of patients?
Patient care lines.
Present and future role of the EU in health care.
Cardio-thoracic surgery - expanding or shrinking field?
Work force in Cardio-thoracic surgery in Europe. What do we need?
The role of the EACTS and CTSNet in improving patient care.
The role of the surgeon - manager in the hospital hierarchy.
The life and fate of a cardio-thoracic surgeon.

Umeå is situated one hour's flight north of Stockholm with good, almost hourly flight connections. Stockholm itself has good flight connections with many European and overseas cities. The Management course will be held in the premises of the University Hospital.

The social programme will include a river rafting tour along an unregulated river, i.e. it has no dams. It is an exciting experience to bump through one of the rapids in rubber boats. Pre- and post course midnight golf tournaments will be arranged be fore and after the Course. In June northern Sweden has almost continuous light. It is therefore possible to play golf through the night.

The programme of the Management Course and registration forms will be sent to all members of the EACTS in December.

Follow-up of goals discussed during the Symposium for the Future in Mallorca

Inner democracy of the Association

One of the items discussed in Mallorca was how we could strengthen the inner democracy of the Association. The danger inherent in an Association is that it ages and that the revitalisation process of always getting new minds in to work for it is hampered. The communication lines between the elected officers and the members should be facilitated and strengthened. This problem has been discussed within the Council. One of the measures taken is to instigate the junior membership. In this way we assure the presence of the future generation of cardio-thoracic surgeons and can take part of their views.

Another measure has been the work to establish the European Board of Thoracic and Cardiovascular Surgeons. It may sound far fetched to claim that a Board, primarily an educational tool, is also a way to strengthen democracy within the Association. However, the Board was a necessary step in order to come into conversation with and exert influence within the EU. We are now at a much better position to make your wishes come true.

I would like to put the following questions to all members. What are your wishes? What are your problems? In what way can the Association be of service to you? How can the Association and the Annual Meeting become better? As I see it, it is the members who exert the democratic process. This requires initiative. The Council is bound by the Constitution, the rules of tradition, and time constraints. The Council is ready to change these conditions after consent of the General Assembly, but we need a closer communication with you! My correspondence with members has increased over the years, but I still feel that your views are not always expressed. The Council welcomes your contribution to the Secretary General of EACTS by fax +46 90 785 36 01 or by e-mail: eacts.secretary@mailbox.calypso.net.

Torkel Åberg, M.D., FETCS
Secretary General

The European Board of Thoracic and Cardiovascular Surgeons

The Board is on a slow but steady course to reaching one of its goals, the recognition of a monospecialty by the European Union. The process is time-consuming and will take another one or two years. Meanwhile the Board has been working on obtaining common standards for thoracic and cardiovascular surgery in Europe.

Cardiovascular examinations took place in Brussels on September 19, 1998. Like last year there were again some last minute withdrawals of candidates. Out of the remaining 9 candidates, seven passed the exams and two failed. The thoracic exams will take place on October 24 in Portoroz, Slovenia, in conjunction with the annual meeting of the European Society of Thoracic Surgeons.

There have been many applications to the Board for recognition under the "grandfather clause". Over 160 have now been accepted. We would like those, who have been recognised by the Board, to make use of their right to have the suffix FETCS behind their names in order to make the Board and its goals better known.

The Board will move its office in the near future, the new address, and contact numbers will be published in due time. Until then application forms and additional information can be obtained from the present address:

European Board of Thoracic and Cardiovascular Surgeons
Leiden University Medical Center, Department of Cardiothoracic Surgery, K6-S
P.O. Box 9600, 2300 RC Leiden, The Netherlands
Tel: +31 71 5264022, fax +31 71 5248284
Bank. ABN/AMRO, Bank acc. no. 48.28.94.490

Hans Huysmans, M.D., FETCS
Chairman

PS from the Secretary General:

If you are not yet a FETCS, write immediately to the European Board of Thoracic and Cardiovascular Surgeons in order to become one under the grandfather clause (without examination).

Deceased Member
John Aksnes, Oslo, Norway.

Forthcoming meetings of The Society of Thoracic Surgeons (STS), The American Association for Thoracic Surgery (AATS) and European Association for Cardio-thoracic Surgery (EACTS)

1999	25 - 27 January	San Antonio, TX	STS
	18 - 21 April	New Orleans, LA	AATS
	5 -8 September	Glasgow, Scotland	EACTS
2000	31 Jan - 2 Feb	Fort Lauderdale, FL	STS
	30 April - 3 may	Toronto, Ontario	AATS © 1999 European Association for Cardio-Thoracic Surgery.