NEWSLETTER
March 1999

LETTER FROM THE PRESIDENT

Cardio-thoracic surgery in the United Kingdom has been under intense criticism and scrutiny in the wake of the widely publicised General Medical Council enquiry into the outcome for a small proportion of children having heart surgery in Bristol. This enquiry has been the catalyst in unleashing widespread public questioning of all medical practice, together with a generally hostile media attitude towards doctors in general. The Government, and the General Medical Council in particular, have responded by proposing new regulatory bodies, as well as a system for revalidation of specialists and general practitioners, linked to continued registration. The exhortation is that we should demonstrate regularly that we are up-to-date and fit to practise, or else lose our registration as specialists.

In the United Kingdom our specialty has already taken a lead in responding to this new, unsympathetic climate, by requiring all cardio-thoracic surgeons to report their own outcomes for the most commonly undertaken procedures to our national Society, where results which arouse concern may be further investigated.

Our colleagues in North America have been similarly challenged, and in response, public access to surgical mortality for individual surgeons is now well established in some States. No doubt similar pressures will be felt across the rest of Europe.

We face a difficult problem. No-one could disagree with the need for those in medicine, and particularly those in a specialty such as cardio-thoracic surgery, to be up-to-date, fully informed and well practised in techniques. The problem is to find practical ways in which this overall competence can be achieved, maintained, and demonstrated at a time when advances in our specialty, and medicine generally, are accelerating, and where financial and workload pressures seem to act increasingly against us.

To some extent the agenda for regulation and accountability will be set by Government agencies, but we must have an important role as a profession. This is where the European Association for Cardio-thoracic Surgery can be involved. It already takes a lead in education and training through its annual meeting, postgraduate courses and the Journal. Its activities in supporting CTSNet and ECSUR should help in establishing uniform reporting of practice and ready dissemination of information. However, we may need to do much more to ensure that our members stay up-to-date and informed. A system such as the American one of re-certification may well become a feature of European practice, and this would be an opportunity for our Association to lead.

There can be few occupations in which one is welcomed to observe others in their place of work and hear of their results and problems without secrecy or rivalry. This openness and willingness to share experience and knowledge is one of our greatest assets, and is a feature that has struck me most forcibly during my association with EACTS, as well as with the other professional societies in North America. EACTS has made great strides in its 12 years of existence and is well placed to help us all through the coming years of changing public and political perceptions of our profession. Our efforts in enhancing the educational role for our Association have never been more appropriate, and will be an increasing feature of future activities. One fact is abundantly clear to me - there is no future for the individualist or ‘loner’ in cardio-thoracic surgery; collaboration and communication with others is essential, indeed inevitable. This, it seems to me, is the ultimate raison d’être for EACTS.

David Wheatley, MD
President

Report from the Treasurer and Secretary General

Economic Status

In the last Newsletter, the financial situation after the financial year 1997-98 was described. The Association incurred a loss of £343,003, and a stiff programme of cost reductions and income increase was instigated.

We are very pleased to be able to tell you, that we believe that the problem has now in principle been rectified. We have scrutinised every expense, we have questioned our level of ambition in various areas and come up with a programme of cost reductions and income increase that leave our core activities untouched and indeed able to further develop.

The accounts for the year 1998-99 are not yet closed. Indeed, the financial result of the Brussels meeting has not yet been finalised, although most of the facts are available. However, we know that the expenditure during this particular financial year will be markedly reduced.

The programme of cost reduction will of course be most effective from the financial year of 1999-00 and forward. During this year, we have also been able to solicit additional income from various sources. The budget for the Glasgow meeting has had several revisions and now promises to give us a handsome profit to be used for Association activities.

In the attempt to improve finances a method has been instigated which constantly surveys and keeps detailed budgeting both as regards the Annual Meeting and the Association itself. This will give us a better control of our finances and will give us an early warning if budgets are not adhered to.

Report from the Secretary General

Democracy within the Association

As previously mentioned in several Newsletters, it has been felt among the Council that the participation of the membership in the work of the Association leaves some things to be desired. Among other things, the participation in and indeed the conduct of the General Assembly could be improved upon. Please use your privilege and plan to attend the General Assembly in Glasgow Monday 6 September 1999!

These issues were discussed at length during the November Council Meeting in Madrid. A small committee consisting of Deirdre Watson and José Pomar were asked to produce a report giving suggestions for improving matters.

Negotiations with ESTS

During the last year talks have been conducted with the leadership of the European Society for Thoracic Surgeons. It has been felt from both societies that Cardiac and Thoracic surgery belong together, that we already have a friendly and constructive collaboration in the European Board of Thoracic and Cardiovascular Surgeons, and that there should be one major Journal in Europe covering the entire Cardio-Thoracic surgical area. Collaboration as regards the Journal has been proposed by the ESTS and a tentative agreement has so far been suggested by the EACTS.

IT Development

The EACTS homepage has developed and improved continuously. Do you have a question as regards the Association, do you need a registration form or other information, please visit the web! Are you missing information in any certain area, please let us know by sending a memo to the Secretary General at the address: eacts.secretary@mailbox.calypso.net.

For the first time in the history of EACTS electronic submission of abstracts will be possible from 1 March 1999. This will expedite your submission and facilitate in all steps of the handling of abstracts. For further instructions please see the homepage at http://www.eacts.org However, submission of abstracts in the usual paper form is of course also possible.

Submission of Abstracts

The deadline for receipt of abstracts is 1 April 1999. Please find Instructions to authors and the Abstract Form in the Preliminary Programme, the EACTS homepage, and in the European Journal for Cardio-Thoracic Surgery. May we ask you to note the following rules, which are strictly kept by the Association.

Authors submitting an abstract should sign an agreement to hand the ready manuscript in at the time of the Annual Meeting. Failure to submit manuscripts will prevent the authors to make any presentation in the Annual Meeting during the next two years. The same principle applies for no-shows, i.e. when the author fails to present his material and has not sent a substitute; or if he withdraws his submitted paper after the first revision by the Editorial office.

The reasons for these stiff rules are that failure to adhere to the conditions of participating in the Annual Meeting prevents the timely distribution of important scientific material, wastes time of colleagues expecting a well run meeting and makes life difficult for the Meeting and Editorial officers. The same rule applies for our two American sister organisations.

Registration Fee for Junior Members

During a Council Meeting held in San Antonio in January, it was decided that those applying for Junior Membership would as a one-time occurrence this year have free access to the Annual Meeting. This means, that applicants for Junior Membership whose applications are complete by 30th April, will be regarded as members when registering for the Glasgow meeting. Please inform your own junior colleagues and ask them to apply for membership before the 30th of April. The membership application form is available from the EACTS Executive Secretariat or on the EACTS Homepage at the address: http://www.eacts.org

Memberships

So far this year has been most successful in soliciting new members of the EACTS. A total of 65 surgeons have so far completed their membership application, out of which 19 surgeons are applying for junior membership. The Membership Committee under the chairmanship of Allessandro Mazzucco is to be congratulated.

Torkel Åberg, MD, FETCS
Secretary General

Committee Reports

Report of the Membership Committee

According to the EACTS constitution, the membership committee shall consist of seven members, each representing a different European country with the highest number of active membership. It was agreed by the Committee and by the Council, in order to foster knowledge about the EACTS and to promote the applications for membership, to identify a group of delegates for countries not represented within the committee, who could support and strengthen the work of the committee itself. The following members have agreed to act as delegates for their countries:

Walter Klepetko, Austria
Dimitrios Dougenis, Greece
Ivan Jelic, Croatia
Alexander Tschirkov, Bulgaria
Queiroz Joao Melo, Portugal
Arpad Peterffy, Hungary
Alejandro Aris, Spain
Robert Dion, Belgium
Jarle Vaage, Sweden

Alessandro Mazzucco
Chairman

Report of the Postgraduate Education Committee

Postgraduate Courses

Arrangements have been completed for the Postgraduate Courses to be held on Sunday 5 September 1999 just before the Annual Meeting of the Association in Glasgow. The topics and speakers for this year are available on the EACTS website and will be published in due course in the booklet for the conference. Last year, we had over 800 surgeons attending these courses and we expect more this year. Early booking is advised.

During the last years, the Association's role in basic education has increased markedly. The postgraduate courses in conjunction with the Annual Meeting have met with increased attendance. The creation of the European Board of Thoracic and Cardiovascular Surgeons with its examinations has underlined the need for the Association to become more involved. The Postgraduate Education Committee has proposed a number of courses as having the stamp of being "Under the Auspices of the EACTS", and Council have approved the following annual arrangements:

• Applied Basic Sciences, organised by Tom Treasure and Jules Dussek in London.

• Thoracic Surgery Course held by Thomas Molnar in Budapest

• Review Course in Cardio-thoracic Surgery organised by Tim Graham and Robert Bonser in Birmingham, UK

• Meeting for Senior Trainees organised by José Revuelta in Spain

• Courses in Cardiovascular Pathology organised by Gaetano Thiene in Italy

Further information about these courses to which you may very well send your trainees may be obtained by the organisers or through Maud Zingmark at the office of the Secretary General.

The Postgraduate Committee has asked the Council for permission to include two representatives of those surgeons still in or just finished with training. We felt that this was an important step towards ensuring that the content of the courses reflected the needs of trainees. The Council has agreed to this important change.

Geoffrey H Smith
Chairman Postgraduate Education Committee

Report of Research and Research Funding Committee

The Committee has begun its work by attempting to raise the profile of research in cardio-thoracic surgery and to establish a database of European cardio-thoracic centres undertaking laboratory-based research where young surgeons can obtain exposure to experimental methodologies. A questionnaire was designed to elicit the nature of the research undertaken, resources available, and feasibility of providing research training opportunities for young surgeons, and this was mailed to 404 individuals in 299 centres in 39 European countries.

136 responses were received from the 299 centres (46%). Response rates varied widely; being best from western European countries.

Commonest research interests for these centres include cardiopulmonary bypass, cardiac physiology, new surgical techniques, myocardial preservation and cardiac transplantation (30-50%). Arterial conduits, heart valves, and atherosclerosis, are subjects of research for 20-30%. For 10-20%, interests lay in investigating artificial hearts, gene transfer, imaging techniques, immunology, and pulmonary transplantation. Fewer than 10% reported research in thoracic oncology and oesophageal physiology.

79% of responders indicated a willingness to take young surgeons for research training. Of these, 55% had their own research laboratory; 66% had access to other laboratories; and 91% collaborated with basic scientists. However, fewer than 10% had funds available to pay the salary of trainees.

There are, therefore, sufficient European centres active in research related to cardio-thoracic surgery, with a willingness to train young surgeons, to make a research training initiative practical. Specific research interests can be identified, but in most cases it will be necessary for the centre or the trainee to identify funding sources. The Committee is presently compiling a list of these research centres which are to take young surgeons for training in research. Details are to be published on the EACTS website.

David Wheatley, MD
Chairman

Report of the East European Committee

The East European Committee, founded in 1995, has continued to expand its activities over the years. Forty-one fellowships for Eastern European colleagues (18 adult cardiac, 12 pediatric cardiac, 11 thoracic) have been granted thus far. Fellows originated from practically all European members of the former Soviet block, 39% coming from Russia. Host clinics were located in most Western European countries, the fellows generally preferring central and northern European clinics (18) and those in the UK (16), mainly for reasons of language. One fellow each went to Prague and to Houston, Texas.

Another major item of support has been short-term professorial visits, 5 colleagues going from West to East and 2 the other way. Clinics in Germany and Sweden delegated professors, as did those in Russia and The Czech Republic. Three such visits are presently in preparation for 1999.

More recently, the Committee has emphasised short-term visits of teams comprising surgeons, cardiologists, anesthetists, and other personnel in various numbers and combinations. Such visits, especially when mutual, and thereby leading to close clinic-to-clinic co-operation, have had a remarkable impact on the parties involved. Four such visits took place between western and eastern units and 6 in reverse. Teams originated from Germany and Sweden and from Moldavia, Romania, Russia and the Ukraine, respectively. Another 5 team visits are presently being prepared for 1999.

One of the major concerns is the grotesque lack of non-disposable and disposable equipment that our colleagues in Eastern Europe are facing. As an exceptional arrangement, substantial material help was provided by Sahlgrenska Hospital, Gothenburg, to the Kemerovo Heart Center, Siberia, by the Heart Center Northrhine-Westfalia to the Institute of Cardiovascular Surgery, Kiev, and by the German Heart Center, Berlin, to the Cardio-surgical Center, Cheliabinsk.

As a new approach, the EACTS is sponsoring a Workshop at the Tomsk Cardiological Center, Siberia, in June 1999. The Western attendants comprise Profs. F. Beyersdorf, Freiburg, B. Hucin, Prague (leader of the delegation), and E. Janssen, Utrecht. Topics of discussion will be ECC and cardioplegia, surgery for congenital and adult heart disease and non-pump CABG. This symposium is supported by W.L. Gore & Associates Inc., Flagstaff, Arizona, and Dr. F. Köhler Chemie, Freiburg, Germany. Colleagues interested in this event should contact Prof. V. Shipulin, Tomsk, fax no. +7 382 2555483, mailto:shipulin@cardio.tsu.ru

Funding of the East European Committee now approaches US$ 420,000 of which about 1/4 came from the EACTS, the remainder being generously donated by our industrial partners. Major and continuing support was given by Jostra, the Johnson & Johnson Philantropic Fund and Sulzer Carbomedics. In addition these companies contributed importantly to the efforts of the EACTS: Asta Medica, Bayer Vital, W.L. Gore & Associates, Dr. F. Köhler Chemie, Mundipharma, Sorin Biomedica, St. Jude Medical, Sulzer International, and 3 M Medical.

The varied activities of the Committee have been extremely well received by our partners in Eastern Europe and have been a source of joy and satisfaction for all concerned. The impact of these efforts also has exceeded initial expectations by far.

In view of the continuing need for stream-lining eastern European cardio-thoracic surgery, the Committee greatly welcomes any help and suggestions it can obtain from the members of the EACTS and, of course, from our industrial partners. We wish to extend our cordial thanks to all who have supported this crucial enterprise!

Hans G. Borst
Chairman East European Committee

Other News

The European Board of Thoracic and Cardiovascular Surgeons

The office of the European Board has moved. The new contact details are as follows:

European Board of Thoracic and Cardiovascular Surgeons
P.O.B. 2023
1990 AA Velserbroek
The Netherlands
Tel. +31 255 520 950
Fax +31 255 523 353

Hans Huysmans, MD, FETCS
Chairman

Second Management Course in Cardio-Thoracic Surgery

As earlier announced, a Second Management Course will be given in Umeå, 18-20 June 1999. The following topics will be highlighted and discussed:

On the Look-Out: What goes on in society? The need for look-out and a strategic view, Present and future role of the EU in health care

Some Basic Management Tools: The needs of the patient and of the personnel as a starting point in the management of a cardio-thoracic unit, Quality improvement in cardio-thoracic surgery - Methods and possibilities, Guidelines and audit. Tools for the government or for the surgeon?

Management Research: Management in multi-professional organisations (MPO), The difference between private and public organisations, Possibilities for cross-fertilisation, Hospital Stay. Scientific background and examples, What determines the outcome of the patient?

Collaboration with the Industry: Industry's view on collaboration with cardio-thoracic surgery

The Cardio-Thoracic Surgeon: The performance of a surgeon, The life and fate of a cardio-thoracic surgeon

Back to the future: The role of the CTSNet in improving patient care, The role of the large associations in improving patient care

You have earlier received the Programme and a Registration Form. For further copies, please contact Maud Zingmark at the office of the Secretary General.

The Life and Fate of a Cardio-thoracic Surgeon

Attached to this Newsletter is a questionnaire constituting the beginning of a project trying to describe the life and fate of a cardio-thoracic surgeon. It will try to answer the question whether cardio-thoracic surgery brings occupational hazard, and - if so, what might be done to avoid such hazards. . Please fill in the questionnaire, which will be anonymously handled, and return it to the Secretary General before Friday 9 April 1999. The questionnaire follows immediately after the text of this Newsletter and can be downloaded. Please contribute with your experiences! They are valuable.

The questionnaire will of course not be able to answer the full picture of the life and fate of the cardio-thoracic surgeon. In order to do that we would need a long-term study of young trainees and follow them for the extent of their lives. In lieu of the perfect, we will have to make do with the less than ideal. Nevertheless, I ask you to fill in the questionnaire to the best of your ability. The results will be analysed and presented at the Management Course and related back to you either via a Newsletter, on the homepage, or - if interesting enough - in our Journal.

STOP PRESS!

New ensuite accommodation in Glasgow

Too late to include in the Preliminary Programme, EACTS is pleased to announce the availability of accommodation in a brand new building. Within very easy walking distance of the Scottish Exhibition adn Conference Centre, the University of Glasgow offers EACTS delegates accommodation in single study bedrooms, all with private facilities, telephone and computer data points. Breakfast is included in the very favourable price of £ 30 per night.

As well as proximity to the venue, the new building (which will not be available to students until after the EACTS meeting) is also within easy walking distance of the cosmopolitan west end of Glasgow, with its numerous restaurants, bistros and bars. Close by too is the Kelvingrove Art Gallery and Museum, and the University's Hunterian Art Gallery, with its famed Whistler collection and Charles Rennie Mackintosh House.

For further information and reservations, please contact the EACTS Executive Secretariat

Important Deadlines 1999

1 April Abstract receipt at the EACTS Executive Secretariat, London
31 May Registration for Second Management Course, Umeå
1 July Early registration fee for 13th Annual Meeting, Glasgow
17 August Pre-registration for 13th Annual Meeting, Glasgow

Future Meetings

1999

18-21 April New Orleans, LA AATS
18-20 June Umeå, Sweden EACTS Second Management Course
5-8 September Glasgow, Scotland EACTS

2000

31 Jan. - 2 February Fort Lauderdale, FL STS
30 April - 3 May Toronto, Ontario AATS
7-11 October Frankfurt, Germany EACTS

2001

29 - 31 January New Orleans, LA STS
6-9 May San Diego, CA AATS

How to contact the EACTS: