Developing a sustainable cardiac surgery programme in LMICs

Joint Efforts to Develop Sustainable and Resilient Programs

Yankah C1. Lajmi M2, du Toit H3, Oketcho M4, Mwambu TP5, Mazri F6, Bouzid A7,  Reis M8, Ferreira MB9, Sadaba JR10, Malaisrie C11, Cuertas MM12,  Oburu G13, Mvondo C14, Nwiloh J15 , Smit F16, Reddy D17, Farkas E18, O’Brien B19,  Urban20, Thameur H21, Pienaar M22, Engbers F23, Buys DG24, Falk V25, Marath A26, Centella HT27, Bokenkamp R28.

German Heart Centre Charité Berlin, Germany1, University Hospital, Tunis, Tunesia2, Catholic Hospital, Windhoek, Namibia3, Uganda Heart Inst, Makerere University, Kampala, Uganda4, Uganda Heart Inst, Makerere University, Kampala, Uganda5, Univ hospital, Algiere, Algeria6, Cardiovasc. Dept., Univ. of Algiers, Algeria7, Maputo Heart Institute, Maputo, Mozambique8, Maputo Heart Institute, Maputo, Mozambique9, Snr. Consultant, Cardiac Surgery, Hospital de Navarra, Universidad Publica de Navarra, Pamploma, Spain10, Chair, STS Workforce, Intern Education, USA11, Cardiothoracic Surg, Heart Centre, Leipzig; Germany12, Kenyatta National Univ Hosp, Nairobi, Kenya13, Dr. Charles Mvondo, Head, Paediatric Cardiac Surgery, Shissong Mission Hospital and Heart Centre, Shissong, Cameroon14, Dr. Nwiloh Heart Center, Adazi, Nnukwu, Nigeria15, Univ. of Free State, Bloemfontein, South Africa16, Dr. Darshan Reddy, Durban Heart Centre, Durban, South Africa17, Dr. Emily Farkas, Associate Professor of Surgery, Associate Director of Global Health Surgery, Indianapolis, IN, USA18, Prof. Benjamin O’Brien, Director, Cardiac Anesthesiology & Intensive care Medicine19, International Operation Centre for Children (IOCCA), Asmara, Eritrea,20,  Hospital Clinique Intern. Clinique Montplaisir, Tunis, Tunesia21, Dr. Michael Pienaar, Pediatric cardiac ICU, Univ of Free State, Bloemfontein, S. Africa22,  Dr. Franciscus Engbers, Pediaric Cardiac Anesthesiologist, Leiden, The Netherlands23,  Prof. Daniel G. Buys, HOD, Pediatric Cardiology, Univ of Free State, Bloemfontein, S. Africa24, Prof. Volkmar Falk, Director German Heart Centre Charité Berlin & Director, Thoracic &  Cardiovacular Surgery, Germany25, Dr. Aubyn Marath, Paediatric & Adult Cardiothoracic Surgeon, President, CardioStart Intl., St.Petersburg, Fl, USA26, Prof. Tomas Hernandez Centella, Dept of Pediatric Cardiac Surg. Hospital Ramon Y Cajal-Serv Cirugia, Madrid, Spain27, PD. Dr. Regina Bokenkamp, Snr. Consultant Pediatric Interventional Cardiologist, Leiden Univ Medical Centre, Leiden, The Netherlands28

Introduction

Cardiac surgery began in North and South Africa in 1953 in Algiers, Algeria and in 1958 in Cape Town, South Africa by Jean Demirleau and Christiaan Barnard, respectively. Many other surgeons followed suit in sub-Saharan regions. In West Africa: 1960 and 1964 by Charles Easmon in Accra, Ghana, 1975 in Enugu by Magdi Yacoub, 1976 in Abidjan by Dominique Metras, 1980 in Liberia by Charles Yankah, in East Africa: 1970 in Kampala, Uganda by, Lindsay Grigg and 1973 in Nairobi, Kenya by, Eddy Knight. Human heart transplantation was pioneered by Christiaan Barnard in 1967 and bridge to heart transplantation by Willie Koen and Charles Yankah in 2001 in Cape Town.

To date the high-tech complex cardiac surgery programs have not gained the expected stability and sustainability in sub-Saharan regions except in South Africa.

Various constraints are being experienced in the healthcare delivery systems in sub-Saharan Africa (SSA), namely weak health infrastructure, limited tools, inadequate human resource capacity, limited public financing to the health sector as a whole (and not only to disease specific programs), poor administrative management, ineffective strategic planning of integrated health systems and misapplication of human, technical and financial resources.

Sub-Saharan Africa is faced with an enormous demographic and economic challenges when we look at its population of one billion (1.1 billion, World Bank, 2022). Of these, an estimated 43% (430 million) are under 15 years old and about 60% (600 million) are under 25 years old. In 2050 the population of SSA will double to 2.4 billion (WB). Besides the burden of congenital and rheumatic heart disease, the increasing incidence of ischemic heart disease among the rising middle class poses a time bomb which will impact on the socioeconomic development.

Despite greater efforts by humanitarian aid missions in the underserved regions and limited local cardiac surgery capacity in sub-Saharan Africa (SSA) easily treatable conditions become chronic and deadly diseases. The surgical load of 400 open heart surgery (OHS) per million recommended by WHO is not yet achieved by many centres in SSA even the minimum 40 open heart surgery per million recommended by PASCaTS.

Our report will discuss the concepts for developing cardiac surgery in underserved regions in Africa and impact measurement of humanitarian activities.  PASCaTS has conducted a survey on clinical cardiac surgery in sub-Saharan Africa and the challenges especially capacity building, treatment and surgical performances of heart centres in sub-Saharan Africa.

Pan-African Society for Cardiothoracic Surgery (PASCaTS)

The African Heart Seminar (AHS) was the predecessor of PASCaTS which really developed as a pure outreach project in the sub-regions of East and West Africa.

In 2001 Professor Charles Yankah from the German Heart Centre Charité in Berlin and Dr. Willie Koen from the Christiaan Barnard Memorial Hospital in Cape Town initiated artificial heart to bridge heart transplantation in Africa at the Christiaan Barnard Memorial Hospital using the “Berlin Heart”. It was a successful startup that was rebranded to PASCaTS. PASCaTS is a prime example of the transformation of ‘brain drain” to “brain circulation” of African surgeons and their contribution to the development of cardiac surgery on the continent.

Global burden of congenital and rheumatic heart diseases and disparities in surgical care in Africa

Though, cardiovascular surgery has now gained recognition as a legitimate component of universal healthcare in the developing and emerging economies, it remains challenging to many national healthcare providers in low and middle income countries (LMICs).

Children born in Europe, United States or in the Western World with congenital heart disease (CHD) such as septal defects, right or left ventricular outflow tract obstruction, AVSD, DORV, Ebstein anomaly, TGA, are generally well supported by the infrastructure relating the pediatric heart care and do receive the surgical management they need in a reasonable time period.  Care pathways are clearly set up and the Government financial support systems for regional healthcare are well established, although these are not perfect. Yet millions of children in Africa born with the same congenital heart disease and those with acquired preventable rheumatic heart disease (RHD) and constricting pericarditis, endomyocardial fibrosis (EMF) are awaiting medical/surgical care that will not likely come in their shortened lifetime because pediatric cardiac care centres and surgical specialists are not adequately available.

Many children don’t reach the stage of early diagnosis and treatment due to financial constraints or lack of medical professionals to deliver cardiological services. About 250,000 children with congenital heart diseases (CHDs) require urgent surgery in SSA. Unfortunately, many Infants don’t reach their first birthday and die from congenital heart diseases (CHD) which is estimated to be as high as 48% or more. When the children survive into adulthood ( > 18 years of age) with CHD an estimated 76% of them will develop heart failure and die.

About five million people world-wide develop rheumatic heart disease (RHD) and causing 300,000 deaths a year. Two thirds of them are children. It is estimated that 817,000 children in sub-Saharan Africa with RHD will likely die in failure and be denied the opportunity to get surgical palliation or cure. Within the continent of Africa there is also wide variation in countries in terms of preventative education, available medication, and ongoing surveillance of afflicted children. Access to community screening programs is so limited that RHD is thought to be responsible for up to 30% deaths among school children in Uganda; In Ghana, by contrast, it is only 1-5% in Ghana. Poor availability, compliance to prophylactic and postoperative penicillin therapy, and congestive heart failure are now recognized as the principal predictors of a mortality from heart disease. Fatal outcomes are also associated with austere and severely deprived socioeconomic living conditions, poor school health education programs (SHEP) and accessibility to cardiac surgery. The recent survey by PASCaTS in 2022 revealed 30% rate of rheumatic valve repair in children as compared to 10% in 2012.                                                 

A strong political will to address cardiac disease, a long-term hospital partnership with its Healthcare Ministry and well thought strategic planning are required to develop a sustainable infrastructure and reduce disparities in access to surgical therapy.

In view of available limited and fragmented resources in SSA, centres in low-resource regions must engage with the MOH to develop low budget cardiac surgery and lead to providing more reliable access to cardiac services to the underserved.

Promoting cardiovascular education in Africa in partnership with EACTS, German Heart Center Charité Berlin, national and international centres.

Partnership with international institutions and EACTS as a professional organization for transfer of know-how is required to promote translational cardiovascular surgery in African centres to deliver efficient services and better outcome.

The main objective of Pan-African Society for Cardiothoracic Surgery (PASCaTS) is to promote a networking among heads of department of heart centres and cardiovascular physicians in Africa, in diaspora and the international community of cardiovascular physicians interested in cardiovascular health care in Africa. It has been pursuing continuing educational programs since its inception:

  1. Since 2011 PASCaTS has been organizing digital educational programs (webinars) in collaboration with German Heart Center Charité Berlin and our international cardiovascular partners. During the COVID-19 epidemic the webinars were held monthly and bimonthly. EACTS has been supporting on-site educational programs during the annual meetings entitled “ Joint EACTS/PASCaTS session..
  2. PASCaTS has been organizing Berlin-Africa workshops with speakers from Africa, China, Europe, India, Japan, South America and USA streamed to many African heart centres. It hosted a special delegation of Nigerian heart surgeons and hospital CEOs in collaboration with German Heart Center Charité Berlin in conjunction with World Health Summit

It has become the leading organization for cardiothoracic surgery practice in Africa, partnered by the German Heart Center Charité Berlin as a partner institution and by European Association for Cardiothoracic Surgery (EACTS) as a partner professional organization to support its cardiovascular surgical and educational activities, respectively.

The Joint EACTS/PASCaTS-GHC 2023 takes place on Thursday, 5th October at 13:45 – 14:45  (FOCUS SESSION) during the 37th EACTS annual meeting in Vienna. The theme is: “Clinical & translational cardiac surgery in low volume settings: Impact on sustainability & resilience in the global south health system

The forum will identify and discuss disparities in cardiac surgery services in Africa, capacity building, and advanced training for the cardiac programs; the role of skill training on simulators and clinical research are now recognized as essential tools to build this clinical structure.

Low volume cardiac centres in Africa: Clinical and capacity building programs in Africa

Developing heart surgery program demands the highest level governmental support,  philanthropy, a dedicated multidisciplinary team approach, profound know-how, leadership, international collaboration and the civil society.

Currently, cardiac surgical practice in SSA is supported to a varying extent by “fly in Safari” missions for 7-10 days to perform 15 – 20 surgical procedures and additional 30-150 open heart surgeries (OHS) per annum by the local teams. In some charity missions, the visiting team carry out the role of first assistants so that the local program leaders can develop their experience in the primary caregiving (and surgical) roles.

Impact measurement of the surgical performance is required for improvement of the services. In 2022 a survey of cardiac surgery capacity and performance of heart centres from six Sub-Saharan African countries (population 193 million) and four South American countries (population 117 million) was conducted. The ratio examining heart centre / number of heart surgeons / open heart surgery/million population for Africa was, 1:12 million, 1:4.5 million and 4:1 million respectively for Africa. By contrast, for South America it was; 1:1.6 million, 1:373,802 and 116:1 million, respectively.

In response to the great demand for clinical cardiac surgical services for the underserved communities in sub-Saharan Africa, PASCaTS started its clinical surgical program in 2010. Global Heart Care (GHC) as a task force was established for undertaking clinical surgical missions. It was formally inaugurated in 2022 and initiated missions for interventional cardiology to enhance the cardiovascular services in West Africa. GHC attempts to form a collaborative a network with African heart centres to help develop and improve cardiovascular interventions and surgeries in the context of north-south and south-south cooperation.

Its first successful mission was devoted to interventional pediatric cardiology procedures at the new University of Ghana Medical Centre (UGMC), Accra in May 2023. It was a joint multi-institutional mission (Germany, The Netherlands and South Africa).

Training the trainers programs for maintaining surgical skills

Although visiting teams do provide teaching programs during their short visits, the local surgeons in low volume centres need further regular surgical practice to maintain their skills.

 PASCaTS has also been promoting and providing skill training courses for African surgeons practicing in low volume centres. Since 2019 it has provided simulation courses to young and senior surgeons in Africa to develop new surgical skills and and greater familiarity and comfort to take on more complex cases during their professional life.

These courses have included skill training on aortic and mitral valve repair, AVSD repair, Ozaki operation, and operative correction of TGA. The courses were held in Accra, Berlin and Milan under the tutorial guidance of Dr. Susan Vosloo, Prof. Tomasa Centella, Prof. Ottavio Alfieri, Prof. Michele de Bonis, Prof. Manuel Antunes, Prof. Joachim Photiadis, Prof. Joerg Kempfert and Prof. Yankah.

While developing a concept for south-south development cooperation we are currently seeking valve repair experts for on-site mentorship within the designated hubs of the sub-regions of Africa to assist this training development. PASCaTS established three regional simulation centres in Africa: Accra, Ghana, West Africa; Nairobi, Kenya, East Africa and Blida, Algeria, North Africa in 2019 and 2022. An  additional centre within this collaborating network is in Bloemfontein, South Africa.

Promotion of clinical research

A] In 2022 PASCaTS initiated multi-centre non-randomized studies on “Concomitant Tricuspid Annuloplasty during Rheumatic Mitral Valve Surgery”. [The results will be presented on 5th October 2023 at the 37th annual meeting of EACTS in Vienna].

B] PASCaTS gives since 2022 an annual EACTS/GHC-PASCaTS Excellence Award.  The prize is awarded for the best abstract on “Rheumatic Heart Valve Disease and Management of Associated Tricuspid Regurgitation” presented during the annual EACTS meeting. The abstract selected for this year’s award is entitled “Mid-term results of Ozaki aortic valve neo-cuspidization for rheumatic aortic valve disease: a prospective multicenter trial” We congratulate Dr. M. Sanad, Mansoura et al. for the award of €1,000 donated by Prof. Yankah

The unmet cardiac surgery capacity and performance in SSA

Ongoing cardiac surgery tourism: Those with some financial reserves fly themselves to India, South Africa or elsewhere for treatment and leave those patients who are among the poorest, behind.

The WHO recommendation for 400 open heart surgeries (OHS) per million population is not yet achieved, even the PASCaTS recommended 40 OHS per million is unmet by many centres in SSA.

We recommend that NGOs, industries and governments approach the medical care of children and those at risk of developing cardiac disease supported by a Universal health coverage plan. In some locations in which there is individual wealth, these may possibly be supported by philanthropic trust funds.

Though, cardiovascular surgery has now gained recognition as a legitimate component of universal health in the developing and emerging economies, it remains challenging to many national healthcare providers in low and middle income countries (LMICs).

A need for new concepts and strategic plans for sustainability and resilience  

The cardiovascular health constraints experienced in the health delivery systems in SSA is therefore alarming. The leading health policy makers in SSA are expected to continue to play a crucial role by promoting effective models in collaboration with the visiting teams that will develop sustainable cardiac programs as opposed to fly in Safari missions.

As already recommended, there is a call to action among experienced ( + senior/retired) surgeons to take the initiative to lead this efforts on a full time pro bono basis to complement  the contributions from  government subsidies [Aldo Castaneda].

Full time dedicated teams focusing on developing regional hubs. It involves an investment of two million USD per annum for the salaries of a European heart team for two-three years. This concept was proposed by PASCaTS.

Rheumatic valve surgery in children and adolescents is becoming less frequent in some African countries (middle income) due to arising from improved pediatric care and access to penicillin therapy for rheumatic fever. Moderate to severe valvulopathies from Rheumatic heart disease develop scarring, deformation and progressive heart failure. Many of these present clinically beyond third to fourth decade and may be beyond repair and require replacement. Some intermediate to high risk patients may be considered for catheter based valve implantation.

The burden of cardiovascular disease in Africa is also becoming more prominent in life style related ischemic heart disease which is on the rise among the emerging middle class of African society. The recent studies of Pan-African Society for Cardiothoracic Surgery (PASCaTS) in 2022 revealed 5% CABG operation of the surgical load in SSA.

Conclusions

This article seeks to call upon stakeholders, foundations of global cardiovascular healthcare, professional organizations, industries and policy makers to focus on the needs of LMIC’s.

It is vital to establish regional centres of excellence to improve capacity building programs and surgical performance to provide adequate service to increasing number of patients among a growing population of 1.14 bn. (projected to double by 2050).

Prof. Dr. Charles Yankah

Cardiothoracic & Vascular Surgeon

President, PASCaTS-GHC`

Director, Humanitarian Cardiac Surgery – GHC

E-Mail: [email protected]  Phone: +49-172-3020143

“Invitation to Pan-African cardiothoracic surgery summit 2025 in Ghana

PASCaTS has earmarked 2025 to organize a three day Pan-African Cardiothoracic Surgery Summit in Africa with its partners EACTS and STS to be held in the first quarter of 2025 in Accra, Ghana, inviting the global cardiovascular community to become fully engaged.  Exact date for the summit will be announced and communicated after the EACTS meeting in Vienna. It will be a platform to strengthen its global network of heart centres and partners, develop mutual cooperation with the industries and activate north-south and south-south cooperation. A Pan-African Health Technology Summit will follow after the surgical meeting. The health tech summit aims at sharing knowledge in artificial intelligence in healthcare with academia, scientists, policy makers, civil society and the industries and prepare for future challenges. It will also provide a platform for improving clinical and university-business-technology partnership programs”.

Acknowledgement

We highly acknowledge the cooperation and contributions of the following colleagues for supporting the project.

Amanda Fowler, Vice President, Global Corporate Giving Executive Director, Edwards Lifesciences Foundaion, Irving, USA, Dr. Brian Duncan, Vice President, Medical Affairs, LivaNova, USA, Prof. Marko Turina, Prof. of Surgery, emeritus Dean, Univ of Zurich, Switzerland. Prof. Pieter Kappetein, Chief Medical Officer, VP, Medtronic, The Netherlands, Prof. Norberto de Vega, em. Cardiac Surgeon, Univ. of Malaga, Spain, Joachim Photiadis, Director, Pediatric Cardiac Surgery, Prof. Joerg Kempfert, Snr. Consultant Cardiac Surgeon, Dr. Mustafa Yigitbasi, Consultant Pediatric Cardiologist, Prof. Christoph Knosalla, Snr. Consulatant Cardiac Surgeon, PD. Dr. Axel Unbehaun, Snr. Consultant Cardiac Surgeon & MICS, PD. Dr. Christoph Klein, Interv Cardiologists, Dr. Frank Merkle, HOD, Cardiovascular Perfusion Academy, All from German Heart Center Charité Berlin, Germany,  Dr. Andreas Kastener, Pediatric Cardiologist, Berlin, Ped. Cardiology Clinic, Berlin Germany, Dr. Rainer Kuhly, Consultant Anesthesiologist and Intensivist, Charité Medical University, Berlin, Germany, Constanze Buenner, Sophie Wolter, Ilka Brinkema, Intensive Care Nurses & Instructors, Charité Medical University, Berlin, Germany Berlin, Dr. Robert Wetzstein, Pediatric Cardiologist, Federal Military Hospital, Berlin, Germany, Anna Smit, Pediatric Anesthesiology Nurse, Leiden Univ. Medical Centre, Leiden, NL; Prof. Nicole Nadgyman, Snr. Consultant Congenital & Paediatric Cardiologist, Prof. Julie Cleuziou, Deputy Director, Prof. Juergen Hoerer, Director, Pediatric Cardiac Surgery, Prof. Markus Krane, Director, Adult Cardiac Surgery, German Heart Center Munich, Germany, Dr. Joachim Hebe, Co-Director Center for Electrophysiology Bremen, Lead of Pediatric and Congenital Heart Electrophysiology, Bremen, Germany, Prof. Michael Huebler, Director, Pediatric Cardiac Surgery, Univ Hospital Eppendorf, Hamburg, Germany, Dr. Susanne Vosloo, Consultant Pediatric Cardiac Surgeon, Christiaan Barnard Memorial Hospital, Cape Town, S. Africa, PD. Dr. Bettina Pfanmueller, Consultant Cardiac Surgeon, Heart Center Leipzig, Germany, Prof. J. Scott Rankin, Professor, Division of Cardiothoracic Surgery, WVU Heart & Vascular Institute, West Virginia University, Morgantown, WV., USA, Dr Emmanuel Lansac, Snr.

Consultant Cardiac Surgeon, Chirurgie Cardiaque, Institut Mutualiste  Montsouris, Paris, France, Prof. Hans-Joachim Schaefers, Director, Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany, Prof. Jolanda Kluin, HOD, Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands, Prof. Dr. Carlos A. Mestres, Cardiothoracic Surgeon, Vice-President, PASCaTS, Barcelona, Spain, Prof. Jose Pomar, Cardiothoracic Surgeon, Barcelona, Spain, Dr. Ekaterina Ivanitskaia-Kuehn, Consultant Cardiologist, & Intensivists, Heart Centre Coswig and Thueringen Hospital, Saalfeld, Dr. Henning Kuehn, Chief, Dept. of Medicine III, Snr. Consultant Interv. Cardiologist, Saalfeld, Germany, Prof. Mohamed Debieche, HOD, Cardiovasc Surgery, University of Blida, Algeria, Dr. Ulrike Doll, Consultant Pediatric Cardiologist, Univ of Erlangen, Germany, Prof. Christine Yuko-Jowi, Consultant Pediatric Interv. Cardiologist, Kenyatta National & University Hosp., Nairobi, Kenya, Dr. Mark Nelson Awori, Head of Dept. Pediatric Cardiac Surgery, Gertrude’s Children’s Hospital & Kenyatta National & University Hosp., Nairobi, Kenya, Dr. Kow Entsua-Mensah, Consultant Pediatric Cardiothoracic surgeon, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana, Prof. Giovanni Stellin, Director, Pediatric Cardiac Surgery, School of Medicine, University of Padova, Italy, Dr. Bruno Murzi, Director, Pediatric Cardiac Surgery, Massa, Italy both doing charity surgical missions at the International Operation Centre for Children, Asmara (IOCCA), Asmara, Eritrea, Prof. Emile A. Bacha, Pediatric & Congenital Cardiac Surgeon, Chief, Cardiothoracic & Vascular Surg. Cong. & Pediatric Cardiac Surg.,NY Presbyterian Cong. Heart Centre, NY; USA., Dr. Gianluca Torregrossa, Director, Robotic Coronary Revasc. Program, Main Line Health –Lankenau Heart Inst. Philadelphia, USA; Prof. Mario Guadino, Director, Dept Cardiothoracic Surg.,Weill Cornell Medicine, Presbyterian Hosp. New York. Prof. Tomas A. Salermo, Cardiothoracic Surgeon, University of Miami, Vice Chair, Faculty Development & Mentoring: Jackson Health System, Miami, USA.

Sharing the latest thinking in innovation

EACTS’ inaugural Innovation Summit

From papers on the future of the artificial heart and myocardial regeneration, to the latest thinking on mechanical and tissue engineering, and bioprinting, the greatest minds in the world of cardiothoracic surgery and innovation came together earlier this year to share knowledge and ideas at the EACTS’ inaugural Innovation Summit.

Attended by engineers, scientists, surgeons, cardiologists and industry leaders from Europe, North America and South Africa, presenters at the Summit included Anthony Atala, G. Link Professor and Director at Wake Forest Institute for Regenerative Medicine and William Cohn, Director at the Center for Device Innovation, Texas Medical Center, who holds more than 100 patents.

Over the two-day summit a total of 36 presentations were made with four presentations selected by a jury panel to be shared at this year’s 37th EACTS Annual Meeting in Vienna.

Driving better patient outcomes

The Summit is the first step in EACTS’ commitment to a renewed focus on innovation with the aim of driving better patient outcomes, with further announcements expected in the coming months. The presentations will provide those working in the cardiothoracic community with new information and thinking.

Friedhelm Beyersdorf, EACTS Immediate Past President (2022), said, “It has long been my vision that as an organisation we double-down on our commitment to innovation so that as surgeons we can continue to improve outcomes for heart and lung patients. There is already a lot of work looking into existing treatments and how to improve current techniques, but we are now aiming at the next level, how to develop new ideas and completely new concepts and make these part of everyday clinical practice. The conference in April was just the beginning – we owe it to our future patients to ensure we continue to learn and innovate across our profession and throughout our careers.”

Mark Hazekamp, EACTS past President, said, “This is an important first step. Our Association is looking to the future and innovation is fundamental for EACTS members, for the development of our profession and for our patients. The four presentations that will be shared in October are thought provoking and will provide valuable insights to our colleagues from all over the world to help stimulate more ideas and thinking outside of the box. At EACTS we will do our best to help turn concepts into reality.”

Franca Melfi, EACTS Vice President, said, “Sharing information freely among colleagues and a focus on practices that may become commonplace in the future is essential if we are to inspire the next generation of cardiothoracic surgeons. I’m very excited that through the Innovation Summit EACTS has committed to the cross-fertilisation of ideas and collaboration to further innovate developments in our profession.”

Read the EACTS Innovation Report 2023 here.

37TH EACTS ANNUAL MEETING HIGHLIGHTS OF EACTS INNOVATION SUMMIT 2023

Friday 6th October | 13:45 – 14:45

Presentations include:
Shock waves for myocardial regeneration
Opto-electronic implant for rhythm control
Mitochondrial transplantation
Multi-organ repair: controlled automated
reperfusion of the whole body (CARL

EACTS News – latest issue out now

Read the latest issue of EACTS News to keep up to date with the latest news and developments at EACTS.

In this issue, you can find out about:

  • The keynote speakers at the 37th EACTS Annual Meeting, which is just around the corner
  • Our inaugural Innovation Summit
  • The latest findings from the joint ESC/EACTS Left Main Review
  • A brand new exam launched by the EBCTS to assess and recognise the expertise of cardiothoracic surgeons across critical care

 

ESC and EACTS joint statement

2022 joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease

The European Society of Cardiology (ESC) and the European Association for Cardiothoracic Surgery (EACTS) have collaborated on reviewing the evidence for the treatment of low surgical-risk patients with left main coronary artery disease. The review, authored by a panel chaired by Professors Robert Byrne and Stephen Fremes, was published today in the EHJ and EJCTS.

The expert group’s conclusion, after a comprehensive review of all relevant evidence, is that for low-surgical risk patients, both coronary artery bypass surgery  (CABG) and percutaneous coronary intervention (PCI) are clinically reasonable based on patient preference, available expertise, and local operator volumes. They have advised that in future guidelines the class of recommendation and level of evidence for CABG should be Class I and Level of Evidence A, whilst for PCI it should be Class IIa and Level of Evidence A.

Their report and associated materials are now being considered by the Task Force working on a new guideline for Chronic Coronary Syndromes, scheduled for publication in August 2024. Until then, the ESC and EACTS believe that local Heart Teams should consider both the current (2018) guidelines and the findings of the expert group when discussing the management of patients with stable coronary artery disease.

You can read more on this story:

  • Click here to read the Editorial co-authored by Rafa Sádaba (former EACTS Secretary General) and Colin Baigent (Chair, ESC Clinical Practice Guidelines Committee 2020-2)
  • Click here to access the Task Force’s findings: the 2022 joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG.

EACTS Council Nominations 2023

The Council is the governing, decision-making body of EACTS. The Council is made up of up to 15 members who each serve for set terms, in different capacities, acting at all times in the best interests of the Association, our members and ultimately the patients that we serve.

Each Councillor will serve a set term (normally of up to three years) and each year a number of new Councillors are appointed as the terms of current Councillors come to an end. Councillors to be appointed must complete a process of Nomination (detailed below), selection and eventually, ‘election’ by the members at the General Assembly in October 2023.

Vacant Council Positions 2023
This year the following positions on Council are to be filled.  A job description for each position is available by clicking on the title;

 

Vice President
The Vice President will be elected in October 2023 with a view to becoming President in October 2024 and serving a final year on Council as Immediate Past President from October 2025.

Treasurer
The position of Treasurer is vacant on the Council from October 2023 until 2026. EACTS is seeking an EACTS member to fulfil this role who has skills in financial strategy and management, knowledge in accounting and investment, and the availability to commit 8-10 days a year for meetings and attend the EACTS Annual Meetings each year during the three-year term. Due to the nature of this role, a separate finance panel will interview candidates and make a recommendation to the Nominations Committee.

Domain Chair-elect Positions 2023
The position of Domain Chair-elect is nominated and selected (but not elected to Council) up to one year before the incumbent Domain Chair steps down. The Chair-elect will serve on the domain and shadow all the current Chair’s activities including Council activities; they will not attend nor vote on Council itself (other than, in exceptional circumstances, to represent the Domain on Council in the absence of the Domain Chair. In this circumstance, they will not vote). The Nominations Committee will select the Chair-elect positions through the normal nomination and selection process; however, the General Assembly will be invited to vote on the appointment, in the year that the Domain Chair-elect is elevated to the office of Domain Chair (ie, one year following selection).

The Process of Nomination and Selection

Nomination Process
To ensure a fair and transparent process, the EACTS Nominations Committee will oversee the nomination and selection process. This year, the Nominations Committee is made up as follows:

Senior Past President: Peter Licht (Chairman)
Past President: Mark Hazekamp
Immediate Past President: Friedhelm Beyersdorf
President: Patrick Perier
Secretary General: Patrick Myers

Any EACTS member can nominate a fellow member for a specified role on Council (there is no limit to the number of nominations a member can make). For avoidance of doubt, current Councillors, Domain and Task Force members may nominate, but members of the Nominations Committee may not.

In making a nomination, the person making the nomination must write a letter of support that includes:

  • A summary of the contribution that the person being nominated has made to his/her professional field
  • The contribution made to the work of EACTS more broadly by the person being nominated
  • The skills and experiences the person being nominated will bring to Council and the specific role under consideration.

The person making the nomination should, after having received confirmation of the willingness of the nominee to stand for election, send a digital form of this letter, with a brief Curriculum Vitae of the person being nominated, to the Chair of the Nominations Committee via the dedicated EACTS email address [email protected]

Nominations open on Saturday 1 July 2023.

The closing date for Nominations is 6pm (CEST) Friday 4 August 2023.

The Nominations Committee will consider all applications before making a recommendation to the EACTS Council.  Council will make the final decision as to those to be formally presented for election at the EACTS General Assembly on 6 October 2023 (Vienna).

 

 

 

Vacancy: CPG Chair and Committee

Clinical Practice Guidelines (CPG) Committee Chair and Committee Members  

EACTS is the leading professional association for cardiothoracic surgeons and allied health professionals and is committed to providing the highest level of continuing educational activities for raising standards and helping improving outcomes for patients with cardiovascular, thoracic, and vascular disease. The purpose of the Clinical Practice Guidelines (CPG) Committee is to provide comprehensive and regularly updated clinical practice guidelines to assist patients and a wide range of healthcare practitioners in making effective decisions that will have a positive impact on patient outcomes and health-related quality of life.  

EACTS is seeking to appoint a Chair to lead the Committee and approximately 8 Committee members. 

Closing date 

The closing date for both Chair and Committee roles has been extended to 10 May 2023, 5 pm GMT

Chair role 

Read the information for applicants for the role description and person specification, and for information on the application and selection process. Please ensure you include in your application a completed Additional questions for applicants form. 

 

Committee member roles 

Read the information for applicants for the role description and person specification, and for information on the application and selection process. Please ensure you include in your application a completed Additional questions for applicants form.  

How to apply

Please apply via the EACTS Membership User Area

For instructions on how to apply via the EACTS User Area, please click here

Contacts 

If you have any questions please contact the Guidelines Programme Manager [email protected]

FFF Fellowships 2022-23 announced

We are delighted to announce the successful recipients of the 2022-23 Francis Fontan Fund Fellowship programme.

A high number of exceptional applications were received this year, reinforcing the programme’s prestigious reputation amongst the cardiothoracic community. This year’s programme includes seven new fellowships, offering more opportunities for surgeons to expand their knowledge and gain invaluable experience working with leading surgeons in their fields.

Congratulations to the following members:

 

 

 

 

 

 

 

 

 

 

  • Ukrainian Support: Anton Pechenenko, Maksym Rzhanyi, Volodymyr Demianenko and Viktoriia Tymoshenko

 

  • VATS: To be confirmed

 

 

Commenting on this year’s applications, Professor Ruggero de Paulis, Chair of the Francis Fontan Fund, said: “We have received an unprecedented number of outstanding applications to the Francis Fontan Fund this year – an increase of 80% in applications received compared to 2021. With 14 Fellowship Programmes to choose from I am proud to Chair the prestigious Francis Fontan Fund. It presents unparalleled opportunities for young surgeons to advance their education and careers in cardiothoracic surgery, learning from experts in their fields in some of the best institutions worldwide.

“It is very encouraging to see so many young surgeons from across Europe and beyond recognise the benefits of taking part in the Fellowship programme and being part of our global cardiothoracic community.”

Viktoriia Tymoshenko, one of the recipients of the Ukrainian Support Fellowship, said: “Let me express my sincere gratitude for such a unique opportunity to be chosen for fellowship in University Hospital Clinic de Barcelona and to be a part of your professional community. It has special meaning for me now when my country is attacked every day with thousands of people wounded. As young Ukrainian surgeons, I want to thank you for your contribution to the development and support cardiac surgery in Ukraine. I see the fellowship as an unrivalled chance to sharpen my knowledge, upgrade my professional skill and gain valuable experience from the leading specialists of hospital.”

Application for the 2023-24 Francis Fontan Fellowship programme will open in Spring 2023. Click here for more information about the programme.

EACTS WiCTS Committee at The 36th EACTS Annual Meeting

The Women in Cardiothoracic Surgery committee held a stimulating workshop at the 36th EACTS Annual Meeting – Embodied Leadership: The Hidden Dimension. The session explored the various ways that practising personal power can help to achieve objectives. We’re overjoyed that the workshop received a high rating!  

Introduced by Secretary General Patrick Myers and diversity expert Mira Vasic, participants were able to take part in practical exercises to for building confidence and resilience. Together, we learnt about the most common, unwritten masculine and feminine rules in the game of power and leadership. It was an honour to see Yolonda Colson in attendance, the 103rd  President and first female President of the American Association for Thoracic Surgery. 

26% of delegates were female at this year’s Annual Meeting and the WiCTS workshop was a first-of-its-kind session attended by 75 men and women. Empowering women surgeons to take up senior positions has become an important priority for EACTS. This workshop, and the WiCTS webinar series, helps to give women the inspiration and confidence to take leadership roles. 

Looking back on the success of the session, Chair of the WiCTS committee, Jolanda Kluin, said: “It was a great opportunity and a pleasure to discuss this topic with male and female surgeons at the Annual Meeting in Milan. I believe that creating an inclusive workplace, a place where everyone feels a sense of belonging, is an important requirement for high quality care.” 

At the Annual Meeting, the EACTS TV channel lifted the lid on sessions, giving the audience a chance to stay on top of hot topics and hear from key opinion leaders in more detail. The second episode of The Big Debate dissected equality and diversity in cardiothoracic surgery with expert panellists: Jolanda Kluin, Franca Melfi, Alicja Zientara, Martin Grabenwöger and Nabil Hussein. The full episode is available to watch via the EACTS Media Library here. 

The WiCTS committee recently launched a thought-provoking webinar series – The changing face of leadership: moving from diversity to inclusion. The series blends theory with practical information from experts and an array of guest speakers, offering vital tools to maintain influence and leadership as a cardiothoracic surgeon in the current landscape.  

Directed by Jolanda Kluin and moderated by webinar coach Maleene de Ridder, the series will run until May 2023 and is free for EACTS members. Non-members can participate for a small fee.  

Learn more about upcoming sessions and register here. 

Thank you to our sponsors for their ongoing support: AtriCure, Edwards and Medtronic.