title: Training of cardiac surgeons for Bosnia and Herzegovina: outcomes in coronary bypass grafting surgery.
abstract: BACKGROUND
  Bosnia and Herzegovina did not have invasive cardiac diagnosis or cardiac surgery before the recent war. With assistance from the United States and Norway, a cardiovascular clinic was developed. This study reports center-specific and surgeon-specific clinical outcomes. Since off-pump coronary bypass grafting surgery was prioritized in the treatment of coronary disease, a comparison was made between operations performed with and without cardiopulmonary bypass.
  
  
  METHODS
  Surgeons and key staff members were trained in the United States. A Norwegian data management system for cardiac surgery was implemented and cases entered after quality review of the data. A total of 1276 patients were entered; operations were performed with cardiopulmonary bypass in 540 and without in 736. The primary surgeon was entered as a variable in an anonymous fashion.
  
  
  RESULTS
  Overall mortality for coronary bypass grafting surgery was 1.6%, and the major complication rate was 4.5%. Patients operated on off-pump received fewer grafts and had a shorter length of stay. Unfavorable outcome was more common in patients when cardiopulmonary bypass was used in the operation. Regression analysis demonstrated that the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and use of cardiopulmonary bypass were predictors of poor outcome. The individual surgeon factor did not impact on outcomes.
  
  
  CONCLUSIONS
  Our study confirms that coronary artery bypass grafting surgery may be performed safely in a poor country in a hospital without experience with cardiac surgery. Selection of talented staff and cooperation with international cardiac centers are crucial. Off-pump coronary artery bypass grafting surgery is suitable for a new center and does not require more training than standard procedures.
authors.affiliation: The Interventional Center, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway. nielsb@aol.com
authors.forename: Jacob
authors.initials: J
authors.lastname: Bergsland
authors.forename: Emir
authors.initials: E
authors.lastname: Kabil
authors.forename: Emir
authors.initials: E
authors.lastname: Mujanovic
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Terzic
authors.forename: Jo
authors.initials: J
authors.lastname: Røislien
authors.forename: Jan L
authors.initials: JL
authors.lastname: Svennevig
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data; D017522:Bosnia and Herzegovina; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000193:education; D004503:Education, Medical, Graduate; D005260:Female; D005550:Foreign Medical Graduates; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D016896:Treatment Outcome; D014481:United States