by F. Van Praet
Dear Colleagues,
It is an honour for me to stand here as your president 2009-2011 leaving the first working year behind me.
As you know, according to the new bylaws, the president is appointed not for a one, but for a two year’s period within a board nominated for 4 years. Next year a new board and president will have to be elected again.
Let me be relatively short in my presidential address since the different projects we have been working on will be addressed extensively by the chairmen of the different committees. Pierre Yves Etienne will update you on the pending reimbursement of Probes for concommittant Afib treatment and inform you about a planned scientific meeting on Afib with experts in the field in Januari 2011. Inez Rodrigus will address the status of the Certificate of Specific Competence in Cardiac Surgery, and Dirk Van Raemdonck will tell you more about the Collegium Chirurgicum , in which the BACTS participates in the different committees and in the General assemblee. He will explain the progress made in creating a Thoracic database and the status of the Accreditation in thoracic surgery.
As I wrote to you all in my October newsletter, I think we can look back proudly on the TAVI symposium of March 19th, 2010 we co-organized with the BWGIC (the Belgian Working Group on Interventional Cardiology). From a scientific point of view it offered a very interesting and balanced overview and update on TAVI procedures. I really want to thank again all the speakers, they did a fantastic job. In the light of the very promising results of the Belgian TAVI registry we had a vivid and tough discussion with Dr. Hans Van Brabandt of KCE who defended the formerly published conservative standpoint of the KCE. However, Belgium being the only one amidst the surrounding countries with no kind of reimbursement, our urgent claim to the government to provide at least some restricted number of implantations, under well-controlled conditions with scientific follow-up found no positive response with the authorities.
The KCE report stated that “The decision whether to reimburse TAVI technology is to be reconsidered when the results of the ongoing US based Randomized Controlled trial (Partner IDE) become available. If this RCT provides evidence on safety and effectiveness of TAVI, its acceptability (cost-effectiveness) and affordability (budget impact) need to be assessed.”
The results of the inoperable cohort (B) of this US Partner trial were published in the NEJM on the 22nd of September 2010 showing a one-year rate of death from any cause of 30.7% with transfemoral TAVI (Sapien) versus 50.7 % in the control group, and a composite rate of death from any cause or repeat hospitalization of 42.5% with transfemoral TAVI versus 71.6% in the control group. At one year the rate of cardiac symptoms was lower in the TAVI group. However TAVI was associated with higher incidence of major strokes and major vascular complications. At one year there was no deterioration of the biological valve function.
We think that those encouraging results are sufficiently impressive to ask the authorities a reconsideration of their policy. Actually, efforts are made by the Board, in synergy with the cardiologists, to get a reimbursement in Category 5, this is to say for a limited number of devices, under well defined and controlled conditions, including data gathering and for a certain time period after which results will be re-evaluated.
The Board decided to participate again in 2011 in the Belgian Surgical Week from 11th till 14th of May 2011, in Ostend. Last year again, although the lectures were interesting enough and well prepared, very few members seem to be motivated to attend the Saturday morning session. In order to make the event more attractive to you all we are evaluating a possible collaboration with the young vascular surgeons, building a program around thoracic aneurysms in a Friday session. This will be decided upon in our next Board meeting.
Dear Colleagues,
Let me finally encourage you all to participate actively as surgeons in different less invasive or catheter based theurapeutic options, especially in valvular disease, coming to us from and in collaboration with the industry. Of course we have to evaluate carefully the possible advantages, opportunities or dangers of those technologies.
If we have learned something from the PCI story , then we should understand that the future will urge our profession to collaborate more in partnership with the cardiologists and that we have to stay involved in those new approaches, …
Let us be the realistic ethical conscience of the cardiologists and remind them now and then of the fantastic results we can achieve with conventional surgery. However, we have to realize that the needed skills for an up-to-date cardiac surgeon are changing dramatically!
Enjoy the meeting!
Thank you!
Frank Van Praet
November 20th, 2011