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Highlighting the Joint AATS/PASCaTS Forum: Enhancing Cardiovascular Education and Skill Training in Resource-Limited Underserved Regions
The American Association for Thoracic Surgery (AATS) and the Pan-African Society for Cardio-Thoracic Surgery (PASCaTS) held their 6th Joint Global Forum at the recent AATS Annual Meeting in San Diego, California. The forum focused on the importance of education and training for cardiovascular health in resource-limited underserved regions, with a panel discussion highlighting the critical topic of patient and surgical safety. Charles Yankah of the Deutches Herzzentrum Berlin in Germany emphasized that the objective of the PASCaTS organization and the Joint Forum was to create a place for the development of cardiovascular surgery in Africa, with the goal of maximizing the sustainability of the current surgical programs.
Dr Yankah began the session by discussing digital health technology as a mechanism for improving cardiovascular education, both for practitioners and for patients. He emphasized that education, health insurance coverage, cost reductions, and efficiency are all necessary to provide better and sustainable care for patients in underserved parts of the world. Another presentation from Francis Smit of the University of the Free State in Bloemfontein, South Africa, focused on education specifically for the healthcare team, discussing a simulation-based training program for cardiothoracic surgery trainees and teams that is being established at the University of the Free State. The program combines a virtual outpatient clinic, multidisciplinary approaches and team training, allied health care professional training, dry skills, a virtual catheterization laboratory and virtual operating room, and intensive care unit management training. Such a program holds the possibility for great impact, but Dr Smit emphasized that the reach and sustainability of the program will depend on financial support from industry, universities, government agencies, and grant funding. He noted that there is not a question of “if” but rather of “when” a large growth of cardiothoracic surgical facilities will be established across Africa, and that it is important to establish training systems for surgery professionals ahead of this expansion.
Two presentations delved into technical approaches in cardiac surgery that have particular relevance across underserved regions in Africa. Taweesak Chotivatanapong of the Chest Disease Institute in Nonthaburi, Thailand, discussed leaflet thinning as an approach to increase the rate of valve repair in patients with rheumatic heart disease. He noted that the ability to repair rather than replace valves is particularly important in communities where rheumatic heart disease is common in younger people. Samir Sarikouch of the Medizinische Hochschule Hannover in Germany discussed right ventricular outflow tract reconstruction with decellularized allografts in children. He presented results comparing decellularized homografts with cryopreserved pulmonary homografts and bovine jugular vein conduits in patients operated both within and outside of the ESPOIR trial. Dr Sarikouch said that patients receiving decellularized homografts are doing well so far, and the researchers plan to follow these patients up to 20 years.
The session closed with a discussion on the importance of patient and surgical safety at medical missions in developing countries, where Drs Smit and Chotivatanapong were joined by Manuel Antunes of the University of Coimbra in Portugal, Carlos Mestres of the University Hospital Zurich in Switzerland, and J. Nilas Young of the University of California Davis in the USA. They highlighted the importance of safety from “day zero” for practical reasons, such as not having access to the array of tools and resources one might have available to them in their home operating theater and intensive care unit, and for more general reasons that underlie program success. Patient and community trust is essential for any such program, and Dr Young noted that having high expectations for safety and tracking safety metrics both provide benchmarks for success that can help drive excellence in a nascent program.