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Reducing the costs of surgical correction of congenitally malformed hearts in developing countries

Published online by Cambridge University Press:  01 August 2008

Sachin Talwar ,
Shiv Kumar Choudhary ,
Balram Airan ,
Rajnish Juneja ,
Shyam Sunder Kothari ,
Anita Saxena  and
Arkalgud Sampath Kumar
Sachin Talwar
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shiv Kumar Choudhary*
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Balram Airan
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Rajnish Juneja
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shyam Sunder Kothari
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Anita Saxena
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Arkalgud Sampath Kumar
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: Shiv Kumar Choudhary MCh, Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi110029, India. Tel: +91-11-26588500; Fax: +91-11-26588663; E-mail: [email protected]
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Abstract

A large number of patients in developing countries require surgical correction of congenitally malformed hearts. Unfortunately, only a limited number of centres offer these patients surgery at an affordable cost. In this review, we discuss the problems in managing these patients, with an emphasis on reduction of costs, so that the maximum number of patients can benefit. It is apparent that containing costs requires a multipronged approach, which begins with timely referral, and continues with early surgical correction and adequate postoperative care carried out in a scientific manner. Indigenization, innovation, training of manpower, and building a team, are essential to cut the costs, and to improve the quality of care.

Keywords

Open heart surgerypediatric cardiac surgerycost reduction
Type
Review Article
Information
Cardiology in the Young , Volume 18 , Issue 4 , August 2008 , pp. 363 - 371
Copyright
Copyright © Cambridge University Press 2008

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References

1.Fyler, DC, Buckley, LP, Hellenbrand, WE, Cohn, HE. Report of the New England Regional infant care program. Pediatrics 1980; 65 Suppl: 375–461.Google Scholar
2.Saxena, A. Congenital heart disease in India. A status report. Indian J Pediatr 2005; 72: 595–598.CrossRefGoogle ScholarPubMed
3.Bickler, SW, Rode, H. Surgical services for children in developing countries. Bulletin of the World Health Organization 2002; 80: 829–835.Google ScholarPubMed
4.Joffs, C, Sade, RM. Congenital Heart Surgery Nomenclature and Database Project: palliation, correction, or repair? Ann Thorac Surg 2000; 69 (4 Suppl): S369–372.CrossRefGoogle ScholarPubMed
5.Rao, SG. Pediatric cardiac surgery in developing countries. Pediatr Cardiol 2007; 28: 144–148.CrossRefGoogle ScholarPubMed
6.Rao, SG. Twists, travails & triumphs of pediatric and congenital heart surgery in India. Indian J Thorac Cardiovasc Surg 2006; 22: 108–110.CrossRefGoogle Scholar
7.Tomatis, LA, Schlosser, RJ, Riahi, M, Stockinger, FS, Kanten, R. Cost containment via expenses rationalization in open heart surgery. J Thorac Cardiovasc Surg 1979; 77: 448–451.CrossRefGoogle ScholarPubMed
8.Ungerleider, RM, Bengur, AR, Kessenich, AL, et al. Risk factors for higher cost in congenital heart operations. Ann Thorac Surg 1997; 64: 44–48.CrossRefGoogle Scholar
9.Airan, B. Cardiothoracic & vascular surgery in India – achievements and future goals. Indian J Thorac Cardiovasc Surg 2005; 21: 133–137.CrossRefGoogle Scholar
10.Tworetzky, W, Mcelhinney, DB, Brook, MM, Reddy, VM, Hanley, FL, Silverman, NH. Echocardiographic diagnosis alone for the complete repair of major congenital heart defects. J Am Coll Cardiol 1999; 33: 228–233.CrossRefGoogle ScholarPubMed
11.Kellenberger, CJ, Yoo, SJ, Buchel, ER. Cardiovascular MR imaging in infants with congenital heart disease. Radiographics 2007; 27: 5–18.CrossRefGoogle ScholarPubMed
12.Kawano, T, Ishii, M, Maeno, Y, et al. Three dimensional helical computed tomographic angiography in infants with complex congenital heart disease. Am Heart J 2000; 139: 654–660.CrossRefGoogle ScholarPubMed
13.Hagemo, PS, Skarbo, AB, Rasmussen, M, Fredriksen, PM, Schage, S. An extensive long-term follow-up of a cohort of patients with hypoplasia of the left heart. Cardiol Young 2007; 17: 51–55.CrossRefGoogle ScholarPubMed
14. Airan B. Should we follow Western guidelines for complex congenital heart disease surgery in India. Presented at the 8th annual conference of the Pediatric Cardiac Society of India, New Delhi, October 14–15, 2006.Google Scholar
15.Talwar, S, Choudhary, SK, Mathur, A, Kumar, AS. Autologous RA wall patch for closure of atrial septal defects. Ann Thorac Surg 2007; 84: 913–916.CrossRefGoogle Scholar
16.Koh, M, Yagihara, T, Uemura, H, et al. Long-term outcome of right ventricular outflow tract reconstruction using a handmade tri-leaflet conduit. Eur J Cardiothorac Surg 2005; 27: 807–814.CrossRefGoogle ScholarPubMed
17.Talwar, S, Mohapatra, R, Saxena, A, Singh, R, Kumar, AS. Aortic homograft: a suitable substitute for aortic valve replacement. Ann Thorac Surg 2005; 80: 832–838.CrossRefGoogle ScholarPubMed
18.Kumar, AS, Talwar, S, Mohapatra, R, Saxena, A, Singh, R. Aortic valve replacement with the pulmonary autograft: mid-term results. Ann Thorac Surg 2005; 80: 488–494.CrossRefGoogle ScholarPubMed
19.Choudhary, SK, Srivastava, S, Chaner, H, Dogra, TD, Venugopal, P, Kumar, AS. Early experience with homograft valve banking. Asian Thorac Cardiovasc Ann 1997; 5: 137–140.CrossRefGoogle Scholar
20.Johnson, LG, Brown, OF, Alligwood, MR. Complications of epicardial pacing wire removal. J Cardiovasc Nurs 1993; 7: 32–40.CrossRefGoogle ScholarPubMed
21.Gaynor, RW. The effect of modified ultrafiltration on the post operative course of patients with congenital heart disease. Semin Thorac Cardiovasc Pediatr Card Surg Annu 2003; 6: 128–139.CrossRefGoogle Scholar
22.Choudhary, SK, Talwar, S, Airan, B, Yadav, S, Venugopal, P. A simplified circuit of modified ultrafiltration. Heart Lung Circ 2007; 16: 113–115.CrossRefGoogle ScholarPubMed
23.Madan, K, Gupta, VP, Singh, R, et al. Comparison of straight sternotomy and interlocking sternotomy in open heart surgery. Indian J Med Res 2006; 124: 57–62.Google ScholarPubMed
24. Talwar S. Choudhary SK. Glenn without bypass. Presented at the 8th annual conference of the Pediatric Cardiac Society of India, New Delhi, October 14–15, 2006.Google Scholar
25.Hussain, ST, Bhan, A, Sapra, S, Juneja, R, Das, S, Sharma, S. The bi-directional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: is it a safe option? Interact Cardiovasc Thorac Surg 2007; 6: 77–82.CrossRefGoogle Scholar
26.Talwar, S, Rajesh, MR, Saxena, A, Subramaniam, A, Kumar, AS. Mitral valve repair in children with rheumatic heart disease. J Thorac Cardiovasc Surg 2005; 129: 875–879.CrossRefGoogle ScholarPubMed
27.Airan, B, Choudhary, SK, Reddy, CSK, et al. Total cavopulmonary anastomosis using atrial septal flap: technique and early results. Indian J Thorac Cardiovasc Surg 2000; 16: 15–18.CrossRefGoogle Scholar
28.Shivaprakasha, K, Rameshkumar, I, Kumar, RK, et al. New technique of right heart bypass in congenital heart surgery with autologous lung as oxygenator. Ann Thorac Surg 2004; 77: 988–993.CrossRefGoogle ScholarPubMed
29.Choudhary, SK, Talwar, S, Airan, B, et al. A new technique of percutaneously adjustable pulmonary artery banding. J Thorac Cardiovasc Surg 2006; 131: 621–624.CrossRefGoogle ScholarPubMed
30.Neirotti, RA, Jones, D, Hackbarth, R, Paxson Fosse, G. Early extubation in congenital heart surgery. Heart Lung Circ 2002; 11: 157–161.CrossRefGoogle ScholarPubMed
31.Sharma, R, Raizada, N, Choudhary, SK, et al. Does inhaled nitric oxide improve survival in operated congenital heart disease with severe pulmonary hypertension? Indian Heart J 2001; 53: 48–55.Google ScholarPubMed
32.Victor, S, Kabeer, M, Nayak, VM. Kiss approach to Cardiac Surgery. Ann Thorac Surg 1996; 62: 1890–1891.Google ScholarPubMed
33.Roberts, DE, Loewene, E, Ostryzniuk, T, et al. Control of blood gas measurements in ICU. Lancet 1991; 337: 1580–1582.CrossRefGoogle Scholar
34.Crow, S, Conrad, SA, Chaney-Rowell, C, King, JW. Microbial contamination of arterial infusions used in haemodynamic monitoring. A randomized trial of contamination with sampling through conventional stopcocks versus novel closed system. Infect Control Hosp Epidemiol 1989; 10: 557–561.CrossRefGoogle ScholarPubMed
35.Alphonso, N, Anagnostopoulos, PV, Scarpace, S, Weintrub, P, Azakie, A, Raff, G, Karl, TR. Antibiotic prophylaxis in pediatric cardiac surgery. Cardiol Young 2007; 17: 12–25.CrossRefGoogle Scholar
36.Robertson-Malt, S, Afrane, B, El Barbary, M. Prophylactic steroids for pediatric open heart surgery. Cochrane Database Syst Rev 2007; 17: CD005550.Google Scholar
37.Blumberg, N, Heal, JM. Mortality risks, costs & decision making in transfusion medicine. Am J Clin Pathol 2000; 114: 934–937.CrossRefGoogle ScholarPubMed
38.Dietrich, W, Thuermal, K, Heyde, S, Busley, R, Berger, K. Autologous blood donation in cardiac surgery: reduction of allogenic blood transfusion and cost effectiveness. J Cardiothorac Vasc Anaesth 2005; 19: 589–596.CrossRefGoogle ScholarPubMed
39.Sharma, V, Talwar, S, Choudhary, SK, Lakshmy, R, Kale, S, Kumar, AS. Evaluation of Epsilon amino-caproic acid (EACA) and autologous blood as blood conservation strategies in patients undergoing cardiac surgery. Heart Lung Circ 2006; 15: 261–265.CrossRefGoogle ScholarPubMed
40.Murphy, PM. Intraoperative transesophageal echocardiography is a cost effective strategy for cardiac surgical procedures. J Cardiothorac Vasc Anesth 1997; 11: 246–249.CrossRefGoogle ScholarPubMed
41.Marymont, J, Murphy, GS. Intra operative monitoring with transesophageal echocardiography: indications, risks and training. Anesthesiol Clin 2006; 24: 737–753.CrossRefGoogle Scholar
42.Sankarkumar, R, Bhuvaneshwar, GS, Magotra, R, et al. Chitra heart valve: results of a multicenter clinical study. J Heart Valve Dis 2001; 10: 619–627.Google ScholarPubMed
43.Joshi, NC, Kumar, AS. Coronary perfusion cannula. Indian J Thorac Cardiovasc Surg 2000; 16: 54.CrossRefGoogle Scholar
44.Moraes, CR. Some aspects of cardiac surgery in the tropics. Eur J Cardiothorac Surg 1990; 4: 235–237.CrossRefGoogle ScholarPubMed
45.Mavroudis, C, Backer, CL. The influence of Plato, and the ancient Polis on a programme for congenital cardiac surgery: the virtuous partnership. Cardiol Young 2007; 17: S2159–S2163.CrossRefGoogle ScholarPubMed
46.Jacobs, JP, Mavroudis, C, Jacobs, ML, et al. Nomenclature and databases – the past, the present, and the future: a primer for the congenital heart surgeon. Pediatr Cardiol 2007; 28: 105–115.CrossRefGoogle ScholarPubMed
47.Jacobs, JP, Wernowsky, G, Elliott, MJ. Analysis of outcomes for congenital cardiac disease: can we do better? Cardiol Young 2007; 17: S2133–S2137.CrossRefGoogle ScholarPubMed