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Jamil H, Ranganathan S, Fissha AB, Vinck EE, Vervoort D. Low-Cost Innovations in Global Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241252441. [PMID: 38828943 DOI: 10.1177/15569845241252441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, costing the lives of 18 million people annually, with up to one-third being attributable to cardiac surgical conditions. Approximately 6 billion people do not have access to safe, timely, and affordable cardiac surgery, predominantly affecting populations living in low-middle income countries. Cardiac surgical care is costly, resulting in few centers in variable-resource contexts operating continuously or with the resources observed in higher-resource environments. As a result, innovations may be formally developed or informally adopted to bypass resource constraints and ensure care delivery. Innovations have been observed across the cardiac surgical care continuum and across settings, potentially benefiting both high-income countries, where growing health care costs are becoming unsustainable, and low- and middle-income countries, where competing health agendas may limit investments into cardiac surgery. This narrative review attempts to address the costs associated with cardiac surgery, placing an emphasis on frugal innovations in the perioperative and postoperative care spectrum.
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Affiliation(s)
- Hera Jamil
- Life Sciences, Department of Biological Sciences, University of Toronto Scarborough, ON, Canada
| | | | - Aemon B Fissha
- College of Health Sciences, School of Medicine, Addis Ababa University, Ethiopia
| | - Eric E Vinck
- Division of Cardiac Surgery, Pontifical Bolivarian University, Medellín, Colombia
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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2
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Gaudino M, Angelini GD, Antoniades C, Bakaeen F, Benedetto U, Calafiore AM, Di Franco A, Di Mauro M, Fremes SE, Girardi LN, Glineur D, Grau J, He G, Patrono C, Puskas JD, Ruel M, Schwann TA, Tam DY, Tatoulis J, Tranbaugh R, Vallely M, Zenati MA, Mack M, Taggart DP. Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate. J Am Heart Assoc 2018; 7:e009934. [PMID: 30369328 PMCID: PMC6201399 DOI: 10.1161/jaha.118.009934] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | | | | | | | | | | | - Antonino Di Franco
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | | | - Stephen E. Fremes
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - Leonard N. Girardi
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - David Glineur
- Division of Cardiac SurgeryOttawa Heart InstituteOttawaCanada
| | - Juan Grau
- Division of Cardiac SurgeryOttawa Heart InstituteOttawaCanada
| | - Guo‐Wei He
- TEDA International Cardiovascular HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeTianjinChina
| | - Carlo Patrono
- Department of PharmacologyCatholic University School of MedicineRomeItaly
| | - John D. Puskas
- Department of Cardiovascular SurgeryIcahn School of Medicine at Mount SinaiNew York CityNY
| | - Marc Ruel
- University of Ottawa Heart InstituteOttawaCanada
| | | | - Derrick Y. Tam
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - James Tatoulis
- Department of SurgeryUniversity of MelbourneParkvilleAustralia
| | - Robert Tranbaugh
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
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4
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Saha KK. Off-pump coronary artery bypass grafting in India. Indian Heart J 2014; 66:203-7. [PMID: 24814116 DOI: 10.1016/j.ihj.2014.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/07/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022] Open
Abstract
Off-pump Coronary Artery Bypass Grafting (OPCAB) is the latest innovation in cardiac surgery. However OPCAB is not adopted universally. Even there have been suggestions of abandoning OPCAB in a special report. In India, OPCAB has been successfully adopted across the board. There are various evidences which favor OPCAB and are discussed in this review. The purpose of this review is to put forward the perspective of the OPCAB surgeons of our country and critically look at the suggestion of abandoning OPCAB.
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Affiliation(s)
- Kamales Kumar Saha
- Private Practice Attached to Multiple Hospitals in Mumbai, C-801/802 Raheja Sherwood, Behind Hub Mall, Off Western Express Highway, Nirlon Compound, Goregaon East, Mumbai 400063, India.
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Goeree R, Blackhouse G, Bowen JM, O’Reilly D, Sutherland S, Hopkins R, Chow B, Freeman M, Provost Y, Dennie C, Cohen E, Marcuzzi D, Iwanochko R, Moody A, Paul N, Parker JD. Cost-effectiveness of 64-slice CT angiography compared to conventional coronary angiography based on a coverage with evidence development study in Ontario. Expert Rev Pharmacoecon Outcomes Res 2014; 13:675-90. [DOI: 10.1586/14737167.2013.838079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ron Goeree
- Programs for Assessment of Technology in Health (PATH) Research Institute,
St. Joseph’s Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences,
McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines (CEM),
St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Gord Blackhouse
- Programs for Assessment of Technology in Health (PATH) Research Institute,
St. Joseph’s Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences,
McMaster University, Hamilton, Ontario, Canada
| | - James M Bowen
- Programs for Assessment of Technology in Health (PATH) Research Institute,
St. Joseph’s Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences,
McMaster University, Hamilton, Ontario, Canada
| | - Daria O’Reilly
- Programs for Assessment of Technology in Health (PATH) Research Institute,
St. Joseph’s Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences,
McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines (CEM),
St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Simone Sutherland
- Programs for Assessment of Technology in Health (PATH) Research Institute,
St. Joseph’s Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada
| | - Robert Hopkins
- Programs for Assessment of Technology in Health (PATH) Research Institute,
St. Joseph’s Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences,
McMaster University, Hamilton, Ontario, Canada
| | - Benjamin Chow
- Department of Medicine,
Division of Cardiology, University of Ottawa Heart Institute and The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Radiology,
University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael Freeman
- Department of Medicine,
St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yves Provost
- Department of Radiology,
Centre Hospitalier de l’Université de Montréal, Montreal, Quebec
| | - Carole Dennie
- Department of Radiology,
University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric Cohen
- Department of Medicine,
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dan Marcuzzi
- Department of Radiology,
St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert Iwanochko
- Department of Medicine,
University Health Network and Faculty of Medicine, University of Toronto, Canada
| | - Alan Moody
- Department of Radiology,
Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Narinder Paul
- Department of Medical Imaging,
University Health Network and Faculty of Medicine, University of Toronto, Canada
| | - John D Parker
- Department of Medicine,
University Health Network and Faculty of Medicine, University of Toronto, Canada
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Shimizu T, Ohno T, Ando J, Fujita H, Nagai R, Motomura N, Ono M, Kyo S, Takamoto S. Mid-Term Results and Costs of Coronary Artery Bypass vs Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease. Circ J 2010; 74:449-55. [DOI: 10.1253/circj.cj-09-0586] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Jiro Ando
- Department of Cardiology, The University of Tokyo
| | - Hideo Fujita
- Department of Cardiology, The University of Tokyo
| | - Ryozo Nagai
- Department of Cardiology, The University of Tokyo
| | - Noboru Motomura
- Department of Cardiothoracic Surgery, The University of Tokyo
| | - Minoru Ono
- Department of Cardiothoracic Surgery, The University of Tokyo
| | - Shunei Kyo
- Department of Cardiothoracic Surgery, The University of Tokyo
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Farrokhyar F, Wang X, Kent R, Lamy A. Early mortality from off-pump and on-pump coronary bypass surgery in Canada: a comparison of the STS and the EuroSCORE risk prediction algorithms. Can J Cardiol 2007; 23:879-83. [PMID: 17876379 PMCID: PMC2651365 DOI: 10.1016/s0828-282x(07)70843-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Early mortality from off-pump and on-pump coronary artery bypass graft (CABG) surgery was assessed and compared with two widely used risk algorithms for CABG: The Society of Thoracic Surgeons (STS) and the European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHOD From March 12, 2001, to December 31, 2002, 1657 consecutive patients were treated with off-pump CABG and 1693 consecutive patients were treated with on-pump CABG. The predicted risk of mortality scores for the STS and EuroSCORE models were calculated. The predictive accuracy for early mortality was assessed by comparing the observed and expected mortalities for equal-sized quantiles of risk using the Hosmer-Lemeshow goodness-of-fit test. The discriminatory power of the models was evaluated by calculating the area under the receiver operating characteristic (ROC) curves. RESULTS The observed postoperative mortality was 1.8% (95% CI 1.3% to 2.4%) for off-pump CABG and 1.5% (95% CI 1.1% to 2.1%) for on-pump CABG. For both on-pump and off-pump CABG surgery, the Hosmer-Lemeshow goodness-of-fit test indicated good accuracy. The area under the ROC curve was 0.81 (95% CI 0.73 to 0.90) for the STS and 0.79 (95% CI 0.71 to 0.88) for EuroSCORE in off-pump CABG (P=0.567). The area under the ROC curve was 0.82 (95% CI 0.73 to 0.91) for STS and 0.81 (95% CI 0.71 to 0.90) for EuroSCORE in on-pump CABG (P=0.616). The STS-predicted risk of stroke, prolonged ventilation and renal failure were similar to the observed data, with relatively good discriminatory powers for both off-pump and on-pump CABG. CONCLUSION Both the STS and EuroSCORE risk algorithms are good predictors of early mortality from off-pump or on-pump CABG surgery. However, the generalizability of these results in the Canadian context would require a broader sampling of Canadian centres, including ones that provide both on-pump and off-pump CABG.
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