by I. Rodrigus
Dear Colleagues and friends,
At the AATS meeting in Boston in 2003, Martin Leon held a provocative speech on drug eluting stents. And with the sentence “You know what ? They work !”, a dispirit mood was falling on all cardiac surgeons in the audience. And at the STS meeting in Tampa and subsequent meetings, we were completely brainwashed on the rush upon percutaneous heart valve technology, which is becoming a reality today. I am sure that every one of us attended cardiology meetings and had to look at these kind of cartoons.
Dear friends, don’t be too sceptic about our job. Maybe the total number of operations has gone down a little bit, but look at these numbers, provided by the Database Committee: he number of CABG procedures has decreased somewhat, but thanks to DES and BMS, we have a good night sleep nowadays. Our invited speaker, Professor Camenzind will tell us all we need to now about DES. The one thing we know, as a surgeon, is that patients do come back for a CABG after some time…So, let the cardiologist treat all those acute infarctions during the night. It’s an opportunity for you to stay fit and do other things in life.
And look at the number of single valve and combined operations. Numbers are significantly rising in Belgium. And why are these numbers rising ? Because cardiologist only begin to understand that a stenotic aortic valve should be replaced in time and that we do have good possibilities to repair a regurgitant mitral valve. They even advocate mitral valve repair in asymptomatic patients. It’s all in their guidelines.
So, don’t worry about the cardiologists, despite the fact that they are the gatekeepers. See these new technologies as an opportunity to attract more patients, but try to work this out together with your Cardiologists. Participate in registrations set up by our own society, so that we can come up with our own data.
The importance of presenting our own data was recently made clear in a meeting with the Technical Council concerning the use of VAD as bridge to transplant. The College collected the data and we counted 32 assist devices as bridge to transplant. The RIZIV-INAMI had less than 20 VAD’s registered ! So where is the thruth ?
In the preceding year, as your president, I frequently wondered what this Society could do for their members. Probably, it is not clear to all of you what the Board has done, besides eating sandwiches and drinking coffee at the Board meetings. With these 10 members, we had 7 Board Meetings. Yves Van Belleghem has left the Board to become president of the Database Committee.
With a very small audience, we approved the new by-laws in December 2006. The main change in these new by-laws is the appointment of the President for 2 years, starting with the presidency of Alain Poncelet from today. As a result, the appointment for the Board members will spread over a 4 year period with the possibility of a never ending reelection. We are aware of the fact that it is very difficult to find dedicated surgeons to serve in the Board. It is not a matter of prestige to be in the Board. It is a matter of dedicated attendance to the meetings.
Last year, we had a lot of worries on the Royal Decree. At this moment, we don’t have a new Governement, we are still waiting for a new Minister of Health and we are still waiting for the verdict by the Council of States. So, nothing changes for the moment and I guess that nobody knows what will happen. As I understood, one centre (Bracops) has been closed and activities were transferred to St Pierre. So, we are with 28 centres now and still waiting for further moves. We did our best to counter the attack of the Royal Decree. I had some meetings with the “Vlaamse Gezondheidsraad”, to defend our speciality and the vision of the BACTS on the necessity of the current link of B2 with B3 and to give our opinions on the Royal Decree. Together with the Flemish Cardiologists we had 2 meetings in order to prepare a common mission statement. Furthermore, we were invited at the cabinet of Minister Demotte. Of course, all this cannot really move the situation, but at least, the Minister apologized for not consulting the Cardiac surgeons before creating a new Royal Decree. But I doubt whether a new Minister will know the difference between a cardiologist and a cardiac surgeon….
In 2007 the BACTS organized a Saturday morning session within the Belgian Surgical Week in Ostend with accreditation points in section 6. In my opinion, it was a very interesting meeting. The lecture by Paul Sergeant and Jan Vesseur on the auditing proces in Nijmegen was really breath thaking. We tried to repeat this lecture in the todays meeting, but Paul could not attend. For those who missed it, the hand-outs of the meeting are available on the website.
Which brings me to a very valuable person for our Society. Carine Vandeweyer is a terrific Datamanager and helps us a lot in improving and updating our website. I can only encourage you to visit the website regulary and to find all information you need. The homepage is adapted regularly. In the section on previous meeting, you can find interesting information and every committee starts putting selected documents on their pages, open for the members.
Furthermore, we decided to open the minutes of the Board meeting for all our members in order to involve you in the work of the Society. The DBC reports of 2003 and 2004 are available to the members only but probably the reports 2005 and 2006 will arrive and will be open to the public.
The Database Committee was reborn under the guidance of Yves Van Belleghem. With his team, he succeeded in presenting 2 very nice year reports 2003 and 2004, with this kind of graphs. With subsequent reports it becomes very interesting to look at the numbers and the evolution of our speciality. Yves will pass over his chair to Bernard Stockman, who will address you after the GA. I can only encourage all of you to send in your data in time, including the error reports. It will be extremely important to come up with correct numbers on our activity, and hopefully this will lead to improvement of quality.
Finding ways to improve quality is the task of the College of Cardiac Surgery. Last year, Jean-Marie De Smet took over my chair as President. We decided to perform a survey to get your ideas on items to be studied as quality indicator in Cardiac surgery in the coming years. At this moment at least 60 surgeons filled out the questionnaire. Be aware that is very important to come up with studies like these. The financial balance of the society depends partially on the contract with the Governement. With the report of the DBC and our survey, we will get 25 000 € in 2007.
Last year, we performed a survey on the use of assist devices which is also available on the website. As a result, we recently had a meeting with the RIZIV/INAMI Technical Agreement Council. Important decisions were put forward: the amount of devices as Bridge to transplant will be augmented to 30 per year. The desirability for Destination therapy will be investigated. And the reimbursement for ECMO/ECLS will be adapted. A very positive thing, in my opinion, will be the possibility to get a reimbursement for treatment of Cardiogenic shock, in the same way as postcardiotomy support. This proposal on cardiogenic shock is at the Council of States at this moment, and will probably be implemented in the near future.
Finally, my heartfelt thanks goes to some of the Board Members:
Alain Poncelet prepared himself as your next president for the coming 2 years. He took over the task of president of the Scientific Committee from Yves Van Belleghem and prepared us a very interesting meeting.
Bart Meyns did an outstanding job as secretary: always right on time, never too late. But unfortunately, he will leave the Board.
The task of the treasurer seems easy: paying the bills. Frank Van Praet performed this job as a good house father. Nevertheless, he will present you a negative balance for the year 2006 and I want to make some remarks in advance. 2006 was an exceptional year with unforeseen costs: remember we had a great 10th anniversary meeting, which, despite the extra input from the industry has cost us 10 000 € extra. The work of the College of Cardiac Surgery normally brings in 20 000 € from the Governement. Alas, in 2005 we could not produce so many invoices, so we lost at least 2000 €. The DBC finalized the reports of the year 2003 and 2004 only in 2006. In 2005, no report was issued. The invoices from the University of Hasselt, for an amount of 12 000 € had to be paid in 2006. Furthermore, the Board decided to encourage young surgeons by creating extra prizes, like the Travel Grant for an amount of 5000 €, the Bergamo and best abstract prize. We feel this is a good and necessary effort for a Society which has some saving at the bank. And finally, the adaptation of the by-laws, with the aid of our lawyer, was not for free. So I hope you don’t give Frank a bad day by disapproving the balance. I can assure you that we had a more economical year in 2007: less lawyer costs, only one year data analysis to be paid, no demands for the Travel Grant or the Bergamo prize. Income from the Governement will be 20 000 € for 2006 and will rise to 25 000 €., but this will be paid in 2008. Therefore, we decided not to increase the membership fee, nor the congress registration.
Jacques Goldstein has done a good job in the Professional Committee, and hopefully the Afib devices will be reimbursed some day…And I hope he wants to continue this job, together with Francis Wellens, despite not being a Board Member anymore.
And Patrick Van Ruyssevelt, another past-president did a tremendous job for our specific competence, not in the least in all the translation work.
I can only admit that has been a pleasure but before all an honour to serve as your president. I am sure we will have an interesting meeting today and that you all find some time to chat during the coffee breaks and lunch time.