title: Paediatric cardiac surgery in a peripheral European region: is a joint programme a safe alternative to regionalisation?
abstract: BACKGROUND
  In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands.
  
  
  METHODS
  An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated.
  
  
  RESULTS
  In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients).
  
  
  CONCLUSIONS
  A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.
authors.affiliation: 1Yale University School of Medicine,Yale New Haven Hospital,New Haven,Connecticut,United States of America.
authors.forename: Gabriele M
authors.initials: GM
authors.lastname: Iacona
authors.affiliation: 2Division of Cardiac Surgery,IRCCS Policlinico San Donato,San Donato Milanese,Milan,Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.affiliation: 3Congenital Cardiac Surgery Service,Vall d'Hebron General Hospital,Barcelona,Spain.
authors.forename: Raul F
authors.initials: RF
authors.lastname: Abella
authors.affiliation: 2Division of Cardiac Surgery,IRCCS Policlinico San Donato,San Donato Milanese,Milan,Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pomè
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Agredo
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Saúl G
authors.initials: SG
authors.lastname: Mendieta
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Forcano
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Sobrado
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Josepha
authors.initials: J
authors.lastname: Suaréz
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Peñate
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Melián
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Volo
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: González
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Marisa L
authors.initials: ML
authors.lastname: Antúnez
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Hipólito L
authors.initials: HL
authors.lastname: Falcón
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Cabrera
authors.affiliation: 5Paediatric Cardiology,Hospital Universitario de Canarias,San Cristóbal de La Laguna,Santa Cruz de Tenerife,Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rubio
authors.affiliation: 5Paediatric Cardiology,Hospital Universitario de Canarias,San Cristóbal de La Laguna,Santa Cruz de Tenerife,Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.affiliation: 4Medical Surgical Unit of Paediatric Cardiology and Heart Abnormalities,Complejo Hospitalario Universitario Insular Materno Infantil,Las Palmas de Gran Canaria,Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Suárez
authors.affiliation: 5Paediatric Cardiology,Hospital Universitario de Canarias,San Cristóbal de La Laguna,Santa Cruz de Tenerife,Spain.
authors.forename: Cesar
authors.initials: C
authors.lastname: Perera
authors.affiliation: 2Division of Cardiac Surgery,IRCCS Policlinico San Donato,San Donato Milanese,Milan,Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002309:Cardiology / Q000458:organization & administration*; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012955:Societies, Medical; D013043:Specialties, Surgical / Q000458:organization & administration*
keywords: Aristotle score; Paediatric cardiac surgery; outcomes; regionalisation of care