Data Base is useful for sharing experience and not a tool for condemnation-Dr.Muneer Amanullah

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Cardiothoracic Surgeon’s annual conference

Data Base is useful for sharing experience and not
a tool for condemnation-Dr.Muneer Amanullah

Self designed database will offer flexibility to change
and modify - Dr. Anjum Jelal

KARACHI: Dr. Saeed Ashraf Consultant Cardiothoracic Surgeon from UK along with Dr. Raj Jutley chaired the second session of 9th annual conference of Cardiothoracic Surgeons held at AKU recently. Dr. Saeed Ashraf himself was the first speaker and he talked about temporary Bi-ventricular pacing. He gave details of CABG cases with less than 20-25 EF, eighty five of their patients had heart failure.
Dr. Abdul Baseer from Lady Reading Hospital Peshawar presented details of Thoracic Database on behalf of Dr. Amir Bilal. The data base was started from June 23, 2003. He then talked about the quality parameters. They compared their results with British Thoracic Surgeons database. Till April 2012, they had 2217 cases of which thirty six were death during operation while overall mortality was eighty eight. Pleural cases were 517 which had 4.6% morbidity. Total admissions during 2012 were 2073. Out of 1420 surgeries, there were thirty six deaths giving a mortality of 2.5%. We have monthly audit and also do academic audit. So far the department has published eighty eight papers of which ten were published last year, he added.
Dr. Farhan Majeed from Rawalpindi spoke about VATS innovations. His presentation was based on 555 procedures of which 135 were done in the last three years. Sometimes TB, he said, also looks like malignancy. VATS decortications was done in forty five cases out of 376 cases of pleurectomy, he stated. Dr. Moiz Akhtar Khan from Liaquat National Hospital spoke on tracheal resection for post intubation tracheal stenosis and gave details of last fifteen years single surgeon experience. Tracheal resection anastamosis was done in sixty five cases of which forty five were male. There was one death and three patients had wound infection. He was of the view that tracheal stenosis surgery is the gold standard for tracheal stenosis. Dr. Saeed Ashraf’s second presentation was on Cox Maze III atrial fibrillation procedure. This, he said, is a less invasive procedure. He also showed a video of modified Cox Maze III procedure. CABG cases were 26%, 51% were mitral valve surgery, triple valve surgery accounted for 5% of cases while 14% were aortic surgery cases. Hospital stay of patients was 12.5 days. The failure rate was 18%. Their overall survival rate was 82% and duration of AF was more than ten years.
Speaking in the next session Dr. Salman Shah gave details of database at Children Hospital Lahore. They collect data on a form. Last year they had 478 cases. Database has details of mortality; renal failure as well as long term follows up. He opined that we have to take interest in our specialty and patient care and database is also useful to protect from the media. We should have benchmark for national standards. He also gave details of Society of Cardiothoracic Surgeons, Brazil and Jordan has joined this database recently. Data Base is of course costly, he remarked.
Dr. Muneer Amanullah from AKU gave details of congenital database wherein they look at mortality, in hospital mortality and thirty day mortality. About 1% of all births, he said, do have some congenital heart disease. In the West its incidence was 25% in 1990 but now it has come down to just 3%. He discussed team based areas of development of database, decrease in operative mortality, re-admissions. Every year about fifty thousand new cases of congenital heart diseases are added to the existing pool in Pakistan and we can just do about 2500 operations at four centers every year. In the past mortality used to be 25% in Pakistan which has now decreased to 10%. This was possible due to dedicated cardiac surgeons, increasing referral pattern, some collaboration, and dedicated congenital heart disease team. Data base, he opined, was the call of the hour as it is useful for sharing experience and not a tool for condemnation. Non validated data is just garbage. We have an open policy and protect institutional integrity. Participating in the discussion Dr. Anjum Jelal said that it is advisable to design one’s own database as one can modify it as the need arises. It will give you flexibility to change and modify.
Dr. Mubashir Khan discussed trainee’s viewpoint about training in congenital cardiac surgery in Pakistan. He said that between forty to fifty thousand children are born with cardiac defects annually; some can be corrected while others can be offered palliative surgery. It is not possible to do complex procedures as required resources are not there. It is cost effective and not drains on hospital resources. VSDs and Tetrology can be treated in time and these children can become useful members in the community. Surgeons, he said, should take lead in managing the patients. Congenital cardiac surgery does not generate enough resources to run this service but it is attractive. Good cardiac surgeon, he said, should be skillful, have good knowledge of anatomy. It is good for good congenital surgeons. He then referred to a paper which highlighted more job opportunities for congenital cardiac surgeons in India. There is no chance for errors and there is need for more hands on training. He also highlighted the significance of training abroad and the feedback. He suggested that we need a structured training programme which should cater to the needs of trainees, institutions and patients. The trainees, he said, should learn more complex procedures under supervision. They must be assured of placement and position so that they can plan their future after completing their training. Integration between different training centers, he said, was very important. He once again emphasized the importance of integration, training duration and rotation in paediatric cardiology. He concluded his presentation by stating that this is a viable independent specialty and future looks bright. Good surgical skills, hard work, resilience and more resilience are needed and above all the trainees must continue learning throughout their life, he remarked.
Dr. Asim Khan talked about current status and future congenital cardiac surgical education. He pointed out that paediatric cardiac surgery is a long training for which one needs passion and perseverance. Paediatric surgery and paediatric cardiology are resource dependent. We have limited facilities for congenital cardiac surgery in Pakistan as compared to the disease burden and many patients die waiting for surgery. The training consists of five to six years in general surgery, two to three years in cardiothoracic surgery followed by one to two years in congenital cardiac surgery. One must have done a minimum of seventy five congenital cardiac surgeries. Cardiac surgery training is Pakistan is available at sixteen centers which are recognized by CPSP and three of them have independent paediatric cardiology departments. Three paediatric cardiac surgeons at Children Hospital Lahore have done over thousand cases. We will accept trainees once we are accredited for which necessary work is underway. CPSP requires the trainees to be trained in ASD, VSD and TOF as well. At present there is no paediatric cardiac surgeon in the faculty constituted by CPSP and they also have no representation in the examiners. We have trained two fellows and both of them have joined Institute of Cardiology at Multan as Assistant Professors. We need more paediatric surgeons, commitment and support of current supervisors and CPSP and desire that paediatric cardiac surgeon should be included in the faculty and examiners, he remarked.