The study assesses the impact of a program using a model of knowledge transfer on the long-term development of a pediatric cardiac service in Lithuania. A team from the United Kingdom evaluated Lithuanian pediatric cardiac services and provided support in areas targeted for improvement. The total number of infant operations performed in Lithuania from 1990 to 2008, together with in-hospital mortality rates, was broken down into 3 time periods and analyzed to estimate the efficacy of the program: (1) 1990-1998, before the program; (2) 1999-2002, during the program; (3) 2003-2008, following the end of the program. Lithuanian results in children older than 1 year were comparable with other European centers. However, only 315 infant and neonatal cardiac procedures were performed between 1990 and 1998, and there was an in-hospital mortality of 34.2%. Between 1999 and 2002, the UK team performed 23 highly complex demonstration procedures (in-hospital mortality, 13%). During the same period the Lithuanian team performed 305 additional operations in neonates and infants, and in-hospital mortality decreased to 18.7%. From 2003 to 2008 results continued to improve-559 infant operations were performed, with in-hospital mortality of 11.3% (P < .0001). Knowledge transfer has led to substantial and sustainable long-term improvement in the results of infant cardiac surgery in Lithuania. Demonstrating techniques and care on a limited number of more complex cases is an efficient way of transferring knowledge and skills to the developing pediatric cardiac centers.
TikslasApþvelgti Vilniaus universiteto Ðirdies chirurgijos centro naujagimiø ágimtø ðirdies ydø chirurgijos rezultatus, juos ávertinti ir padaryti iðvadas. MetodaiNuo 1964 iki 2006 metø Vilniaus universiteto Ðirdies chirurgijos centre atlikta 5066 ágimtø ðirdies ydø operacijos vaikams iki 18 metø.Naujagimiø dalis -307 operacijos (6,1%). Korekcijos naujagimiams atliktos naudojant dirbtinae kraujo apytakà (DKA) ir be jos. RezultataiÁgimtø ðirdies ydø operacijos suskirstytos á keturis etapus. 1974-1990 metai (1974 m. atlikta pirmoji ðirdies operacija naujagimiui). Tuo laikotarpiu mirðtamumas buvo 100%. 1991-1995 metais -mirðtamumas 71%, 1996-2000 metais -mirðtamumas 68%, 2001-2006 metais -mirðtamumas 38%, 2006 metais mirðtamumas -22%. IðvadosAnalizuojant naujagimiø ðirdies chirurgijos rezultatus, paþymëtina, kad per pastaruosius metus mirðtamumas sumaþëjo iki priimtinø dydþiø, kurie artëja prie kitø pasaulio ðirdies chirurgijos klinikø rezultatø. Gerëjant visam kompleksui tyrimo, gydymo, slaugymo priemoniø visose grandyse (kardiologija, anesteziologija-reanimatologija, chirurgija), mirðtamumà ámanoma sumaþinti iki minimalaus.
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