June 1998

Letter from the President

Dear Friends

The President of the Association is elected for a one-year term of office. This is really short, and I have already completed most of this period. When I was entrusted with this position, my main concern was not only to serve the Association, but also to set my own mark. My first and, undoubtedly, most important ambition was to watch over the scientific level of our Annual Meeting. My second ambition was to increase its reputation and attraction with the help of other members of the Programme Committee. On the whole, my aim was not only to maintain, but to improve whatever issue is necessary and possible.

On the above grounds, the Programme Committee met last month to set up very attractive scientific sessions. It was also my privilege to chose and to invite the Honoured Guest Lecturer, Floyd Loop, and the Science Lecturer, Serge Renaud. Floyd Loop is Chairman of Governors of the Cleveland Clinic and Immediate Past President of the American Association for Thoracic Surgery. The challenging title of his Honoured Guest Lecture "Coronary Artery Surgery. The End of the Beginning" will attract a large audience. There will certainly also be great interest in the Science Lecture by Serge C. Renaud, Research Director from Bordeaux. His results are quite renowned and interesting as they prove among other things that daily consumption of olive oil and moderate quantities of wine will protect us from cancer and cardiac diseases. This is also evident in the title of his Lecture "Dietary Prevention of Cardiovascular Diseases". At last, my Presidential Address will be devoted to our near future "Cardiac Surgery in the 21st Century. The Future is Now?".

But the President above all represents our Association. He is a shooting star in a sky where fixed planets play a permanent and essential part. I was asked by the Editor of our Journal, Marko Turina, to help him promote and enlarge the distribution of the European Journal of Cardio-thoracic Surgery, especially in Japan. To attract subscribers to the Journal is a fundamental challenge; this deal is shaping up nicely and I will support Marko Turina in his projects as long as he will wish. Throughout these nine months, I carried out my task in perfect empathy with our Secretary General, Torkel Åberg, the main pivot of our Association, and with Maud Zingmark, Administrative Secretary of the EACTS, who always helped me in a friendly and efficient way.

Last November, Torkel Åberg initiated and organised in Mallorca two very successful events; besides an outstanding Management Course, the EACTS Symposium for the Future helped us to clarify the goals and projects of our Association. As for Marcos Murtra, whom I know since many years, he has demonstrated that he is a real efficient "golden boy".

We also developed closer relationships with the Society of Thoracic Surgeons and the American Association for Thoracic Surgery.

The upcoming meeting in Brussels should from all points of view be a superb event thanks to Paul Sergeant, talented Chairman of the Local Organising Committee and his hardworking team. I will be very happy to welcome as many as possible of you to celebrate the 12th anniversary of our Association.

Eugene Baudet
President



Messages from the Secretary General

EACTS direct telephone line

The administration of the Association and of the Annual Meeting are constantly being improved. The EACTS has now installed a direct phone line to the Executive Secretariat in London 44 (0) 171 647 2351. The phone will be manned during office hours, and an answering machine will take your message after working hours. The earlier announced phone number to the operator is still in use, but it will be easier for you to reach the right contact person by calling the new number.



Information on the Brussels Meeting

Brussels Meeting on http://www.eacts.org

The preparations of the Annual Meeting in Brussels have never before been settled so early in the year as now. The Local Organising Committee has been instrumental in proposing and implementing new and systematic ways of ensuring a successful meeting, among other things using the internet. Visit the homepage to find details on the Meeting. The programmes for the Postgraduate Courses are already on the net, and the full scientific programme will be available for you by the beginning of July. Registration and housing information is available online. Belgians say Brussels is the Capital of Europe, and this may be true from some aspects. The city attracts a lot of people. Make sure that your accommodation is booked in time. University Accommodation is offered at very favourable prices. To make a reservation please contact the EACTS Executive Secretariat.

Deadline for early registration: 15 August 1998. All delegates must register.

Members who have paid their annual dues have free registration until the early registration deadline. After this date a registration fee of ECU 150 will be charged.

Scientific Programme
The number of abstracts this year was the highest ever received by the Programme Committee. 906 abstracts were sent in to CASIL, our Executive Secretariat. The Annual Meeting will encompass 220 abstract or film presentations. As you can understand, it has been a huge and difficult task to select the abstracts to be presented.

This year we have tried an improved way of judging the abstracts. First, members of the Programme Committee judge a category of the abstracts, i.e. valves, congenital heart, transplantation, thoracic general, etc. A scale of 1 to 6 is used in order to grade the abstract. A mean grade is then formed and a cut-off point is selected. This year the cut-off point was 3.6 which left 368 abstracts to be judged a second time by the entire Programme Committee. Again a mean grade was formed. At the meeting of the Programme Committee, the Cardiac General Session and the Young Investigator Award Session were first decided. After this, the Programme Committee split into several smaller groups who, acting with the mean grading as a deciding guide, made attractive Oral, Forum, Poster and Film Sessions within their fields.

This year we introduced more stringent rules about the abstract dead-line. As a result, only forty abstracts (out of a total of around 950) had to be returned. Furthermore, most abstracts were written in the adequate format, which is with the headings of Objective, Methods, Results and Conclusion. The Council and Programme Committee are very pleased about this developmment as it makes the work of both our Executive Secretariat (CASIL) and the Programme Committee easier.

For the next year the Council is contemplating the possibility of the authors sending the abstracts to CASIL via e-mail. This would mean a highly simplified procedure for all abstract authors, and it would further facilitate the procedure as the Programme Committee would then be able to work via e-mail and the selected abstracts could go soon after the Programme Committee meeting on our Home-page (http://www.eacts.org). This could possibly shorten the necessary time frame for the selection of abstracts and make possible the postponing of the deadline. Further information about this development will be given to you during the year. There will always remain the possibility of sending your abstract via normal mail.

Book of Abstracts
The Book of Abstracts will reach you by the middle of August. Simultaneously, the abstracts will be presented on the HomePage. Please advice your collaborators and staff about the existence of the Abstracts on the Internet. They can be reached via the address http://www.eacts.org.

Video Library
The Video Library arranged at the Annual Meeting has been very popular, and there will be one in Brussels as well. We are trying to collect additional videos in order to offer a wide choice of subjects. If you have any interesting videos, we would appreciate it very much if you would be willing to lend or give them to the Association. Please send your videos marked with your name and EACTS 98 to the Executive Secretariat (address on the top front page). The videos should preferably be VHS and on the PAL system, but other formats and systems like U-matic, Secam or NTSC are also accepted. Thank you in advance for your contribution.



Council Decisions

Creation of new Committee

In expectation of the change in constitution as regards junior membership, a temporary Committee has been formed consisting of Hans Huysmans, chairman, Roberto Lorusso, Pieter Kappetein, and Bart Meyns. Their tasks will be to prepare a meeting inviting junior surgeons, to define the task of a permanent Committee, and to suggest members of this future Committee.

Satellite Meetings

As you know, the Industry arranges several Satellite Meetings primarily during the days preceding the Annual Meeting. Upon request by the Industry, the Council has decided to announce these meetings on our HomePage. If you are interested in these activities, please visit http://www.eacts.org.

EURO - The European Value

All financial transactions between members and the EACTS will henceforth be conducted in Euros.



General Assembly

New Members

The Membership Committee under the chairmanship of Allessandro Mazzucco have had 105 new applications for membership to survey. The names of the new applicants have been circulated to all members with the printed version of this Newsletter. For details regarding this list, please contact Mrs. McGree. According to the constitution they will be voted on during the General Assembly in Brussels.

Junior and International Memberships

As announced during the General Assembly last year, the Council had decided to prepare the institution of International and Junior Memberships to encourage a broader representation. This change will be put to the vote during the General Assembly in Brussels. The exact alterations in the wording of the Constitution are given below. The Council has on two occasions scrutinised the new wording, which is now submitted to you for deliberation and comments. If carried, the new Membership categories will be instrumental from that day on. Below is a summary of the meaning and contents of the new membership categories.

Junior Membership can be awarded to any European or non-European cardiac and/or thoracic surgeon in training. The time span during which Junior Membership can be carried is five years. The surgeon then makes a choice of becoming an Active Member.

The privileges under a Junior Membership are as follows:
Subscription to the European Journal of Cardio-Thoracic Surgery;
Free access to the Annual Meeting;
Newsletter; and, as a gift from the American Association for Thoracic Surgery a subscription of the Journal of Thoracic and Cardiovascular Surgery.

The Annual Fee for Junior Membership is ECU 50. Elsevier Science, the publisher of our Journal, has graciously agreed to support our Junior Members with our Journal as a means of expanding its distribution which explains the minimal fee. As you see, the Junior Membership is very attractive. The EACTS, and now also the AATS are in this way supporting our Junior Members and their education. Please inform your Juniors about this opportunity.

International Membership can be accorded to non-European surgeons whose practice is entirely or substantially concerned with cardiac and/or thoracic surgery, and who have achieved distinction in their field.

The privileges under an International Membership are as follows:
Subscription to the European Journal of Cardio-Thoracic Surgery;
Newsletter;
Free Access to the Annual Meeting;

International Membership has an initiation fee of ECU 33, and an annual fee of ECU 198.



Please note in your agenda

Due to recently decided construction work at our proposed venue in Edinburgh at the Annual Meeting in 1999, we have had to change venue to Glasgow. Unfortunately this entails changing of dates



CTSNet

Update your Private Homepage
The Association sometimes has difficulties in reaching members by fax or e-mail due to the simple fact that we do not have these details. This would be easily accomplished if all members would kindly insert their personal details on the internet. Please update your contact numbers by visiting the web address http://www.eacts.org, click on "Members", click on "Update your EACTS information". You will then be asked to enter your password and personal ID, which were sent to you in a Newsletter in November 1997. If you do not have them, please contact Kathy McGree at the Executive Secretariat, direct phone no. +44 171 647 2351, fax no. +44 171 629 3233, e-mail: Kathym@thguk.com.

Please visit the CTSNet booth at any of the major European or International meetings to have your picture taken, if you have not done so already. If you wish the CTSNet staff will assist you to update your personal homepage.



Committee Reports

The Committee structure of the EACTS is now starting to function as anticipated. The chairmen report to the Council. There will also be a short annual report in the Newsletter by those committees that are not by the constitution required to report during the General Assembly.

Congenital Heart Disease Committee

This Committee continues to try and improve the outcome of patients undergoing surgery for congenital heart disease. One of our first initiatives has been to determine how much surgery for congenital heart disease is being undertaken in Europe. This information for 1995 has been collected and will shortly be published in the European Journal of Cardio-thoracic Surgery. There were at least 28,000 operations of which more than 20,000 were with cardiopulmonary bypass. Further attempts will be made to collect outcomes as well as total numbers, and the committee is trying to improve data collection in co-operation with ECSUR.

We are also trying to encourage collaboration between surgeons and to stimulate research and training. With this in mind a "business" meeting will be held during the Annual Meeting in Brussels and all surgeons with an interest in congenital heart surgery are invited. The plan is to discuss non-scientific matters related to congenital heart surgery and surgeons.

Congenital Business Meeting, Monday 21 September 1998, 15.45 - 17.00
Conference room: Dynastie B, level 4, Brussels Congress Centre

The programme for the Annual Meeting in Brussels promises to be excellent and over 100 abstracts were submitted relating to congenital subjects. In addition the Postgraduate course is on Sunday before the meeting and an interesting programme has been arranged. Hopefully congenital heart surgeons will be well represented in Brussels.

James L Monro
Chairman



Thoracic Surgery Committee

The Committee met twice and discussed several issues.

1. Further efforts should be made to unite all thoracic surgeons within EACTS. Actions will be taken through the EACTS Executive Secretariat and by contacting different national thoracic and cardio-thoracic societies. EACTS members are kindly asked to encourage their non member colleagues to apply for membership.
2. In order to improve representation of thoracic surgeons within the Association it has been proposed to have a one in four ratio as a minimum representation within the Council and in different committees. Also one president in four would be a thoracic surgeon. This proposal has been accepted by the Council.

   During the Annual Meeting approximately 25% of the presentations will be within thoracic surgery. Efforts will be made to make this speciality better represented and more visible at the Exhibition .

3. Through the ECSUR database project the possibility is offered to start up a thoracic surgery registry. Diagnosis, procedure, ASA risk and outcome is the information required. The database will be organised in co-operation with the ESTS (European Society for Thoracic Surgery). J. Dussek is the EACTS co-ordinator.
4. The European Board of Thoracic and Cardiovascular Surgeons organised the first exams in thoracic surgery in October 1997. Five surgeons were board certified. The Thoracic Committee will concentrate now on a definition and profile of a thoracic surgeon, and on the content of a training programme in thoracic surgery. In this respect an EACTS-ESTS panel session will be organised during the Postgraduate Course in Brussels.

Toni Lerut
Chairman



EU Liaison Committee

The committee has defined its task more precisely. It will establish and/or maintain the contact with the European Union and the responsible persons in different directorates in Brussels and with other EU committees and institutions about issues concerning cardio-thoracic surgery in general and more specifically education, training and recognition, research funds, legislation, standardisation and regulations for medical equipment and implantable devices.

Together with the PR-department of the EU an information package is at present being prepared, containing all relevant names and procedures. This information will be made available to other EACTS committees (IT Committee, Database Committee, Research and Research Funding Committee, etc.) and others in the EACTS, who want to have it.

The EU Liaison Committee has advised several EU-directorates on the choice of experts in cardiac and/or thoracic surgery to represent the profession in EU-working groups and committees of the medical industry.

Hans Huysmans
Chairman



Industry Relations Committee

The Industry Relations Committee met in Copenhagen in September 1997 and in Boston in May 1998.

The EACTS and the Industry discussed the future annual meetings. It was agreed that careful selection of future venues would be required, because the Association is now considerably larger. It will be important to select conference centres with adequate facilities for both the scientific sessions and the industrial exhibition.

It was agreed that the EACTS would help the Industry with satellite meetings; both notifying the membership and arranging venues. The Industry agreed not to organise satellite symposia during the official programme of the EACTS.

Professor Borst reported on the efforts of the East European Committee to help our colleagues from former communist countries. It is hoped to secure more funds for visiting fellowships.

Jaroslav Stark
Chairman



Database Committee

In a recent meeting of the committee it was reported that the ECSUR project had, on its contacts database, details of 786 cardiac surgical centres and 2980 individual cardiac surgeons (mostly in Europe). The ECSUR website (http://www.ecsur.ic.ac.uk) has been very effective as a means for centres and surgeons to communicate with ECSUR, and for them to learn about the project. The committee learnt that, since data collection started last October, adult cardiac surgical patient data has been received from centres in 12 countries, and now also includes data from some national cardiac surgical registries. Negotiations are underway to receive data from several other existing national cardiac surgical registries.

Data is either collected as a minimum dataset (patient identifier + gender & date of birth, date of surgery, type of surgery conducted, on bypass?, re-operation?), or as larger datasets. Professors Taylor and Sergeant and Dr Wyse are all members of the STS committee and much effort during early 1998 has gone into the preparation of an ‘International’ adult cardiac surgical dataset which will share many elements between the ECSUR and STS (heavily revised for 1999) databases. The EACTS database committee decided that this new dataset should be available for use by the Annual Meeting in Brussels, and will clearly offer an important and much-needed unification of data collection for cardiac surgeons in Europe, USA and indeed, world-wide. The aim of the ‘International’ dataset is to assist cardiac surgeons on many levels - research, development, best practices and the provision of surgically relevant information. However, it also offers a unified approach &emdash; a standard dataset - for those units currently without effective computerised patient management systems (probably the majority) to use both to run their departments, and to contribute to ECSUR. Committee agreed that Diskettes with the minimum and International ECSUR datasets should be available for centres on request. For them, it represents a cost-effective solution for their patient management and international data sharing needs, and many centres have already requested this of ECSUR.

Committee learnt that paediatric and thoracic surgical datasets are under development and will hopefully be launched under the ECSUR framework later in 1998.

It was agreed to have an ECSUR demonstration booth at the Annual Meeting in Brussels, so that surgeons would be able clearly to see the construction and benefits of ECSUR.

The ECSUR web site

EACTS members are invited to visit the ECSUR website. The European Cardiac Surgical Registry (ECSUR) is organised by the Database Committee of EACTS. ECSUR is a cardiac surgical database for cardiac surgeons. Collection of adult cardiac surgical data from centres throughout Europe (and beyond) commenced in October last year. Paediatric and thoracic surgical data will be added later this year.

Currently the ECSUR website is used as communications and informative resource. In time we intend using the site to allow centres to assess and analyse the anonymized ECSUR patient database.

When you log on to the ECSUR website you will find details about :-

* The ECSUR project

* The EACTS Database Committee

* On-line registration forms for centres to describe and introduce their unit to ECSUR

* On-line registration forms for individual cardiac surgeons to introduce themselves to ECSUR

* The ECSUR minimum adult cardiac surgical dataset (we will soon add information about the larger

international adult cardiac surgical dataset developed during 1998 for worldwide use)

* On-line help for data transfer to ECSUR

* How to receive diskettes containing the minimum and International (STS-ECSUR) datasets

You will find the ECSUR website at : http://www.ecsur.ic.ac.uk

For other information, please contact Dr Richard Wyse by telephone : +44 181 383 1902, fax : +44 181 383 1915, or by e-mail : rkh.wyse@rpms.ac.uk



Ken Taylor
Chairman



Audit and Guidelines Committee

A call for help

A case in England, which has run for eight months in front of our General Medical Council, has resulted in the public, the press, and our own professional governing body insisting on compulsory audit and regulation of heart surgery (The British Medical Journal, 6th June 1998;316:1685-1758).

What processes already exist in Europe? Audit may be well developed but it may be in different hands in different countries. Would any member of EACTS who can provide me with a lead, please write directly to me, giving me the name and address of any person or organisation active in this area. A list of contacts is all I need to make a start.

The questions that I would like answered are these:

Are your results monitored nationally or regionally? Is it voluntary or compulsory? Who is responsible for submitting data? What body collates data and keeps the register? Is it anonymous, coded, or publicly identified? What action can be taken on the basis of it? Are there any illustrative cases (preferably in the public domain)?

Tom Treasure
Chairman

St. George’s Hospital, Blackshaw Road, London SW17 0QT, United Kingdom, tel. 44 (0)181 725 3288, fax. 44 (0)181 725 3640



Report on the European Board of Thoracic and Cardiovascular Surgeons (EBTCS)

The EBTCS - not an EACTS committee, but an independent organisation founded by the EACTS, the ESCVS (European Society for CardioVascular Surgery) and the ESTS (European Society of Thoracic Surgeons) - has in its first year recognised 5 surgeons after formal examinations and 153 senior surgeons without examinations under the grandfather clause. The format of the examinations turned out to be successful and will, with some improvements, be the same for this years examinations, for cardiovascular surgery in Brussels on September 19th 1998 and for thoracic surgery in Portoro, Slovenia, on October 24th 1998.

The European Board has now formally opened the discussion with the UEMS (European Union of Medical Specialists) to get recognition of an independent specialty of thoracic and cardiovascular surgery for the countries of the European Union. This will strengthen the position of the specialty and support the activities of the European Board, trying to improve the quality of the specialty by setting standards for training and recognition.

There is an increasing interest in the European Board reflected in the number of applications, from young surgeons wanting to take the exams as well as from experienced surgeons seeking recognition under the grandfather clause. Application forms are available on the internet at the address: ctsnet.org/Residents/European Residents’ Section.

Hans Huysmans
Chairman

Comment from the Secretary General: It is important that we support the European Board. Please show this by applying for recognition according to the grandfather clause.



The German "Heart Valve Scandal" - a Warning

Personal comments by Hans G. Borst

In 1994 heart valve prostheses appeared on the German market whose price was far below the customary. This alarmed the officers of the German public health insurers (Krankenkassen) who immediately concluded with the price difference to have disappeared in obscure channels. The media rapidly latched upon the "good news", claiming that cardiac surgeons and, naturally, their spouses, were spending the money for private purposes. That made a mere suspicion an outright scandal. The origin of these valves soon became apparent. They were illegal re-imports from third world countries where the industry sells prostheses at a lower price (to sell any, I suppose). It took no time for the valve producers to race and plug the leaks using the fabrication numbers.

Nevertheless, a huge avalanche was triggered, quickly in encompassing not only cardiac surgeons but, in addition, cardiologists, anesthetists, pump technicians and even hospital administrators. On the company side, three major firms selling valves, extracorporal equipment, pacemakers, defibrillators as well as catheter devices and accesories, are involved. Investigation by the public prosecutor ultimately was targeted on an unbelievable 1860 persons, including the heads of all German heart centres! The senior "culprits" likewise became subject to special tax investigation.

The charges made include fraud, corruptibility and malfeasance. This comprises the acceptance of gifts and favours such as luxury automobiles and pleasure trips, signing contracts with industrial firms in order to raise product prices and trying out new devices, both to the disadvantage of insurers as well as taking benefits for fake research. The former item, of course, has a criminal character and will be dismissed from further discussion. The others, however, deserve some comment:

The public prosecutor has uncovered an overwhelming evidence of bonus payment on a percentage basis of equipment bought, on questionable research, the use of devices not yet cleared by the FDI as well as on seemingly unwarranted congress traffic. Most of this is in the form of inter-office correspondence of the respective companies, but in some cases contracts were signed between doctors and company personnel. Importantly, it turned out totally irrelevant whether or not the money went to an official bank account of the respective institution, the former generally having been the case.

After two and a half years of investigation and millions spent on this gigantic effort, no one thus far has been convicted on criminal charges and only one surgeon was indicted. However, several persons were given in part substantial fees which were paid for the obvious reason of avoiding indictment.

One can guess that it will take several more years to finish this procedure. The result most likely will be painful for all of European cardiac surgery in that industrial companies will be much more reluctant to fund clinics. In any case, several conclusions appear evident at this stage:

1. 
2. Never sign a contract involving benefits based on the number of items bought.
3. Do not accept any responsibility for buying equipment. Leave that to your administration.
4. Never have overpriced devices ordered without written proof of their superiority.
5. Always sign a formal contract with industrial companies covering scientific studies. Return the funds in the absence of publishable findings.
6. Never have the costs of non-approved devices charged to the insurer.
7. Do not have your personal business travels paid by the industry. Procure written proof of the purposes of industry supported trips of your co-workers.



DECEASED MEMBER:
John D Parker, London.



Forthcoming meetings of the Society of Thoracic Surgeons (STS), American Association for Thoracic Surgery (AATS) and European Association for Cardio-thoracic Surgery (EACTS)

INVITATION TO THE GENERAL ASSEMBLY OF EACTS TO ALL MEMBES

SUGGESTED CHANGES OF THE CONSTITUTION
Junior and International Membership categories to be added