Bijzondere interventies aan het hart - Gezondheidsraad

Accordingly, the situation pertaining to cardiac surgery in the Netherlands is
stable, and poses few problems for patients. Nevertheless, it is still advisable to
pursue a focused quality control policy, which also retains the permit requirement
for centres. One remaining deficiency of this policy is that it does not provide
for a centralised, public, national registration system for the results of openheart
surgery. A system of this kind would enable the results obtained by individual
surgeons and centres to be assessed against the background of accepted
standards.
The follow quality requirement governing the admittance of centres should
be retained: at least 600 heart operations per annum, with each surgeon performing
a minimum of 150 procedures per annum. Given the current collective labour
agreements concerning workload, this means that at least four surgeons should
be available within each centre.
In addition, the quality of care has the most to gain from a situation in which
cardiac surgery and intervention cardiology are practised within a single centre
(fully integrated cardiac centres). If, as a result of special circumstances (including
those of a geographical nature), it is decided to establish PCI centres that do
not include a heart surgery capability under the same roof (off-site centre), then
there should be guarantees regarding effective cooperation with nearby heart surgery
centres.
Treatment of valve disorders
Between 1992 and 2005, the number of heart-valve operations carried out in the
Netherlands grew from well over 2,000 (19% of all open-heart operations), to
around 5,000 (34% of all open-heart operations). The main cause of this increase
was an expansion of the indication, which meant that elderly patients could also
undergo surgery, more safely and with improved results. The influx of immigrants
has also produced an increase in the number of rheumatic valve disorders.
A recent development in the treatment of valve disorders involves the use of
combined procedures. This can mean that, in the course of a single operation,
valve surgery is combined with arrhythmia surgery, for example. In heart-failure
patients with a leaking mitral valve, a valve operation can be combined with coronary
bypass surgery, or with a left ventricular reconstruction. This approach
yields good results.
The indications for valve surgery, too, are still in a state of flux. One important
development is that patients with heart valve deficiencies undergo surgery at
an early stage in the disease process. This keeps the pumping function of the
heart at a better level, resulting in an improved quality of life for the patient.
Executive summary 39