Elsevier

The Annals of Thoracic Surgery

Volume 80, Issue 6, December 2005, Pages 2278-2284
The Annals of Thoracic Surgery

Original article
Cardiovascular
Current Status of the European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons Congenital Heart Surgery Database

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
https://doi.org/10.1016/j.athoracsur.2005.05.107Get rights and content

Background

After utilizing separate congenital databases in the early 1990s, the Society of Thoracic Surgeons (STS) and the European Association for Cardio-Thoracic Surgery (EACTS) collaborated on several joint database initiatives.

Methods

In 1998, the joint EACTS-STS International Congenital Heart Surgery Nomenclature and Database Project Committee was created and a common nomenclature and common core minimum database dataset were adopted and published by the STS and the EACTS. In 1999, the joint EACTS-STS Aristotle Committee was created and the Aristotle Score was adopted and published as a method to provide complexity adjustment for congenital heart surgery. Collaborative efforts involving the EACTS and STS are underway to develop mechanisms to verify data completeness and accuracy.

Results

Since 1998, this nomenclature, database, and methodology of complexity adjustment have been used by both the STS and EACTS to analyze outcomes of over 40,000 patients. A huge amount of data have been generated which allow comparison of practice patterns and outcomes analysis between Europe and North America. The aggregate data from the first 5 years of data collection not only make for interesting comparison but also allow examination of regional difference in practice patterns. For example, in the EACTS, out of 4,273 neonates, 885 (20.7%) underwent arterial switch procedures and 297 (6.95%) underwent Norwood stage 1 procedures. In the STS, out of 3,988 neonates, 472 (11.8%) underwent arterial switch procedures and 575 (14.4%) underwent Norwood stage 1 procedures.

Conclusions

This analysis of the EACTS-STS multi-institutional outcomes database confirms that in both Europe and North America, case complexity and mortality is highest among neonates, then infants, and then children. Regional differences in practice patterns are demonstrated, with the overall goal being the continued upgrade in the quality of surgery for congenital heart disease worldwide.

Section snippets

Material and Methods

The STS Congenital Heart Surgery Database has now undergone four data harvests [1, 2, 10, 11, 12, 13, 14]. The STS data utilized in this manuscript were generated from the most recent three STS data harvests [11, 13, 14], all conducted by the STS Congenital Heart Surgery Database Taskforce and Duke Clinical Research Institute (DCRI). These data come from 24 centers submitting data and represent surgical procedures performed between 1998 and 2003 inclusive. Mortality is reported according to

Results

This combined STS and EACTS analysis includes all harvested cases in either database reported with the nomenclature and minimum dataset of the EACTS-STS International Nomenclature and Database [3]. These cases represent all harvested data in either database from 1998 until the time of submission of this abstract to the 2005 STS meeting. Patients are only eligible for analysis if their discharge status (alive or dead) is known. This report includes 18,928 eligible patients from the STS (3,988

Comment

This analysis of the EACTS-STS multi-institutional outcomes database confirms that in both Europe and North America, both case complexity and mortality are highest among neonates, then infants, and then children. Regional differences in practice patterns are demonstrated and the complex nature of the relationship between annual program volume and outcome is demonstrated. Inferences can be made about the benefits of transcontinental collaboration and cross-fertilization of knowledge.

This

References (28)

  • C. Mavroudis
  • C. Mavroudis et al.

    Congenital heart surgery nomenclature and database project

    Ann Thorac Surg

    (2000)
  • F. Lacour-Guyet

    Risk stratification theme for congenital heart surgery

    Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu

    (2002)
  • F.G. Lacour-Gayet et al.

    The Aristotle scorea complexity-adjusted method to evaluate surgical results

    Eur J Cardiothorac Surg

    (2004)
  • Cited by (73)

    • Young infants with severe tetralogy of Fallot: Early primary surgery versus transcatheter palliation

      2017, Journal of Thoracic and Cardiovascular Surgery
      Citation Excerpt :

      Alternatively, the management of infants with TOF who require early intervention, either secondary to cyanosis or prostaglandin dependence, still varies across western centers.3,5,14 For example, both North American and European registries report a significant prevalence of SPS use for young children requiring staged palliation,14,18 as do various single-center reports.3,5 However, from approximately the mid-to-late 1990s, many large centers, including ours, have almost entirely abandoned SPS shunts as a bridge to complete repair.17,19

    • Mexican registry of pediatric cardiac surgery. First report<sup>✩</sup>

      2014, Boletin Medico del Hospital Infantil de Mexico
      Citation Excerpt :

      Moreover, this registry will be a source of valuable information to achieve regionalization of congenital heart disease surgical practices. Regionalization should be understood as the rational use of existing resources, considering primarily the 12 specialized health institutions with the aim of increasing the number of persons served and improving the quality of services.12–18 With the information obtained in the first report of the RENACCAPE as well as future reports and based on the population and existing resources in each state, the CCINSHAE and the health care sector will be able to intensify regionalization and the establishment of practices based on risk evaluation and stratification (RACHS-1) with periodic evaluations aimed at improving the program.

    • The STS national database

      2014, Annals of Thoracic Surgery
      Citation Excerpt :

      The effort resulted in an International Summit on Nomenclature for Congenital Heart Disease in Toronto in 2001. In 2005, Jeffrey P. Jacobs, MD, and colleagues reported on the addition to the CHSD of the Basic Complexity Score, which rates each operation for various defects by complexity (1.5–15) and level (1–4) based on the EACTS/STS Aristotle Committee recommendations [22]. This was a precursor for a study incorporating the comprehensive Aristotle score and patient risk modifiers to increase the preciseness of the estimated risk.

    View all citing articles on Scopus
    View full text