Blog : heart surgery

Lessons Learned in Humanitarian Cardiac Surgery

Novick Cardiac Alliance had the opportunity to attend the 32nd Annual Meeting of the European Association for Cardio-Thoracic Surgery (EACTS) in Milan Italy in October 2018. Watch the video below of Dr. William Novick and Dr. Marcelo Cardarelli as they discuss “Lessons Learned in Humanitarian Cardiac Surgery.”

 

Humanitarian Footprint

Novick Cardiac Alliance has published a research article in JAMA, a peer-reviewed medical journal published by the American Medical Association. The article is titled “Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery Programs in Low- and Middle-Income Countries”. It describes the cost-effectiveness of providing heart surgery to children in developing countries, but it also accounts for the long-term effects at the individual and societal level.

“The Humanitarian Footprint”, as we describe this the long-term effect, is measured in extra years of life expectancy, extra years of schooling and lifetime income potentially added for the patients treated in our global humanitarian interventions.

It turns out that in 2015 alone, there were 16 932 years of Life Expectancy, 1 484 years of schooling and $67 642 191 lifetime income potentially added to the cohort of patients we operated around the world. We always suspected humanitarian pediatric cardiac surgery was doing something good for our patients and the world. Now we have the data!

Read the full article: Humanitarian Footprint

 

Over 1,000 Hearts Healed in Iraq

 

Dr. Novick with Ayad in Nasiriyah Heart Center

In August 2010, before the end of the Iraq War, Dr. Novick and his teams began traveling to Iraq. We believed that Dr. Novick’s vision to provide cardiac care and surgery to children suffering from heart disease was more important than politics, religion or where these children were born. Over the course of the past 8 years, we have worked in 6 hospitals located in 5 different cities throughout Iraq. In December 2017, we celebrated performing our 1,000th pediatric heart surgery in Iraq.

 

Mohammed – Our 1,000th child operated in Iraq

Mohammed was only 17 days old when he received his life-saving heart surgery from our team in Karbala, Iraq. He was born with Transposition of the Great Arteries and without surgery, the chances of him surviving to be one year of age was slim. Weighing just 3 kilograms, Mohammed’s heart was only the size of a strawberry. Cardiac Alliance surgeon, Dr Marcello Cardarelli and Iraqi surgeon Dr Ahmed Ebra worked together to perform this delicate surgery. Mohammed recovered over the course of two weeks in the ICU and is now home with his parents just outside of Karbala. Mohammed may be the 1,000 child, but there are still thousands more children waiting for heart surgery in Iraq.

 

Since 2010, we have expanded our programs across the country of Iraq, beginning in the north in Sulaymaniyah to the spiritual capitol of Najaf. In the south, we began pediatric cardiac programs in Basra and at two centers in Nasiriyah. Our program in Karbala, located in central Iraq, has flourished with a fast-learning Iraqi pediatric cardiac surgeon. It’s through our collaboration with these 5 centers in Iraq that we have been able to provide life-saving heart surgery for over 1,000 children in Iraq.

Novick Cardiac Alliance is the only organization providing pediatric heart surgeries in Iraq. We strive to fulfill the ever-growing list of children who require surgery to survive. Without our volunteers and supporters, we could not achieve this. Thank you for you continued support.

The World Loses Another Giant in Pediatric Heart Surgery

Dr. Francis Fontan

When receiving the news that Dr. Francis Fontan passed away earlier this week, Dr. Novick’s initial response was “Another giant in pediatric heart surgery passed from our midst.” Dr. Fontan is the individual who pioneered the development of the “Fontan” operation. The Fontan operation made it possible for those children born with one ventricle to have a chance to separate the “red” from the “blue” blood and lead nearly normal lives for many years. Dr Fontan’s contribution to the field of pediatric heart surgery cannot be over-emphasized as it is the final operation which nearly all children born with one ventricle receive thus providing them with a future free of the debilitating effects of chronic cyanosis.

Fontan Procedure

 

Dr. Novick reminisced about meeting Dr. Fontan.

“As a resident in cardio-thoracic surgery at the University of Alabama from 1987-1991 I was fortunate to meet Dr. Fontan on more than one occasion because of his professional and personal relationships with Dr. John W. Kirklin and Albert D. Pacifico. I will never forget my first encounter with Dr. Fontan. He was visiting Birmingham to work on the finishing touches of his sentinel paper with Dr. Kirklin, “The Perfect Fontan”. On the day I had the honor of meeting him I was assigned by Dr. Pacifico to start the second case of the day. As would have it, by design I am sure, it was a child who needed a completion “Fontan.”

As usual this required a redo-sternotomy, which we performed without difficulty. When I sent word to Dr. Pacifico that the sternum was open, I received an unusual response, “Proceed”, which meant he wanted me to lyse the adhesions and place the cannulation sutures to enable the patient to be placed on bypass. I knew that Dr. Fontan was in the hospital and might be visiting the operating rooms, so I was a bit nervous. Nonetheless we proceeded without incident. When I sent word again to Dr. Pacifico that we were ready for him to cannulate and place the patient on bypass, I was again greeted with “Proceed.” This response was totally unexpected as I had never placed a “Fontan” completion patient on bypass, and I was early in my residency. So, as I was placing the arterial cannula, Dr Fontan suddenly appears above the anesthesia screen and says ‘Good morning Dr. Novick!’ Well as fate would have it, I muffed the cannulation and could not get the arterial cannula in. I stopped and responded ‘Good morning Dr. Fontan, sorry I muffed the cannulation, could you please ask Dr. Pacifico to come now.’ Francis laughed and apologized for spooking me at exactly the time I had tried to place the aortic cannula. Remembering this encounter with Dr. Fontan reminds me of the importance of having a sense of humor even while performing challenging heart surgery.”

Francis Fontan, creator of the Fontan operation, actually considered his greatest accomplishment the formation of the European Association of Cardio-thoracic Surgery. He is truly an innovative leader in pediatric cardiac surgery and one of the main individuals responsible for the progress of cardiac surgery in Europe. The world will miss Francis, but we can never forget his tremendous contributions to the field of cardiac surgery, specifically pediatric cardiac surgery. His legacy to this world can be found in the thousands of adults living with Fontan circulation today. We imagine that he and Dr. John Kirklin are together now, perhaps discussing “The Perfect Fontan.”

Perspective from a Perfusion Student

Brooke managing the bypass machine in Kharkiv

Brooke Tracy, a perfusion student from the US, recently joined our team on a trip to Kharkiv, Ukraine. She describes her experience as a student on her first medical mission trip.

“There are no words to describe how amazing and influential my first mission trip with the Novick Cardiac Alliance was, but I can say with absolute certainty I would recommend it to anyone! Not only was the team amazing and so well versed in healthcare skills, but they also were some of the most empathetic and passionate people I have had the opportunity to work alongside. Not to mention the local Ukrainian team. They all were very excited to learn from NCA in ways to improve their practice, and they were incredibly welcoming and appreciative of all that NCA has done for their hospital system.

As a perfusion student, I didn’t really know what to expect as our field is pretty dependent upon technology and supplies. I had done some research on the Ukrainian healthcare system, but was vastly underprepared when it came to fully understanding the difficulties in which the local team has in acquiring, what in our practice, is simple equipment. But the lack of equipment never stumped the local perfusionist. Alex and Olga were some of the most innovative perfusionists I’d ever met. In order to make the most of each piece of equipment, their circuit design and construction was innovative. Both were incredibly knowledgeable, but it was humbling to see how much they each were looking to learn more and grow in their practice.”

NCA Perfusionists John and Brooke working alongside Kharkiv perfusionists Alex and Olga

What she gained as a student: 

“In the end, the most inspiring thing about this trip for me was to see the passion and moral of the local team. The nurses were so compassionate and went out of their way to comfort their patients. They really did an amazing job, especially those that were medical students working night shift to gain experience! You could tell that this hospital served their local community in more than just physical care, as the empathy was overflowing with every patient. The parents were allowed back in the ICU with their children post-op and it made a world of difference in the recovery of our patients.

After returning from this trip, not only had I gained a ton of knowledge and skills from both the NCA team and the local team, but I also had a better appreciation for all of the resources that we have at our disposal in the US. I have developed some new practices and little tricks that make my perfusion practice more resourceful and limit my medical waste since returning from the mission.

Brooke with patient Sofia, who had 60 minutes on bypass during her operation.

I can not only recommend missions to anyone in the field, but especially to students because I feel that it gives you a advantage to being a resourceful, motivated, and passionate perfusionist, which is exactly what this world needs more of.”

-Brooke Tracy, Perfusion Student, South Carolina, USA

Artur from Ukraine: Fighting for His Life

Artur is was born a fighter.

Artur was born on the 1st of September in Luhansk, the easternmost city of Ukraine. Luhansk has been under the control of the separatist rebel group since 2014, and is known as “Luhansk People’s Republic.” This city was nearly destroyed by the war in 2014 and many public services are difficult to obtain, including quality care at hospitals.

When Artur was 5 days old, his mother noticed he was breathing very fast and turning blue. She took him to the hospital in Luhansk but the doctors were unable to give a definite diagnosis and sent him home. Weeks continued and Artur’s mother became more concerned with her baby’s blue color. Again she went to the hospital and after several tests, the doctor thought he noticed something wrong with Artur’s heart. Finally the doctor in Luhansk called the Kharkiv Cardiac Center. This doctor sent a photo of Artur’s chest x-ray to Kharkiv pediatric cardiac surgeon Olga Buchevna and she recommended Artur be transferred immediately to Kharkiv.

 

Upon his arrival at the hospital in Kharkiv, cardiologist Daria Kulikova performed a echocardiogram and diagnosed Artur with Transposition of the Great Arteries, plus a tiny ASD and tiny VSD. This heart defect usually must be repaired within two weeks of age, and Artur’s was very severe. He was not getting enough blood to his body or brain, with oxygen saturation levels barely 50%. His surgery would be complicated. Luckily our team arrived three days later and on October 9th, Artur received his life saving heart surgery. Kharkiv pediatric cardiac surgeon, Olga Buchevna, performed this surgery flawlessly with assistance from Cardiac Alliance surgeon Kathleen Fenton. Artur recovered quickly in the ICU and was drinking milk two days after surgery. His serious facial expressions proved to us that this little boy has a strong will to survive.

There are babies like Artur around the globe, fighting for their lives, waiting for medical assistance to mend their heart defects before it’s too late.

 

Novick Cardiac Alliance Featured on ShareAmerica

Cardiac Alliance has been featured on ShareAmerica, a platform produced by the US Department of State. Our story has been shared to all the US Embassies worldwide. This particular story can be translated into seven different languages. Read the article on ShareAmerica to learn more about our life-saving work in war-torn areas.

Witnessing Sustainability in Libya

Two brothers, Four heart defects.

In 2012, we met Abdul, a Libyan boy who was born with four heart defects, called Tetralogy of Fallot. Dr Kathleen Fenton operated on Abdul alongside Libyan pediatric cardiac surgeon Dr Wejdan Abou Amer. Because his heart defects were diagnosed late, Abdul was very sick following his surgery and remained in the ICU for many days. Our team was scheduled to leave the country, but Dr Fenton changed her flight to stay and help the Libyan team care for Abdul. 

Abdul, 2012

In June, our team returned to Benghazi and met Abdul’s little brother Mohammed. Mohammed has also been diagnosed with Tetralogy of Fallot. His parents were devastated to learn their second son also had a life threatening heart defect. It is “life threatening” because he lives in war-torn Libya with limited basic health care available, let alone pediatric heart surgery. 

Mohammed, 2017

Since our team has been visiting Libya and educating the local Libyan medical professionals for several years, we are witnessing the magic our work accomplishes. Mohammed needs a type of surgical procedure that the local Libyan surgeon Dr Wejdan can now perform on her own! Dr Fenton collaborated with the Libyan team and determined that Mohammed’s surgery can be performed by Dr Wejdan after our team leaves the country. From our continued teaching, she has developed the skills to do this, and the ICU team has the skills necessary to care for a patient like Mohammed. 

Dr Wejdan and Dr Fenton operating in Libya.

Without our continued perseverance to travel to Libya, children like Mohammed and his brother Abdul would not survive. There would be no miraculous story to tell. 

And by the way, Abdul is now 6 years old and attending school! 

Cardiac Alliance’s collaboration in war-torn Benghazi brings sustainable healthcare to children

Reuters journalist Ayman al-Warfalli recently interviewed our team in Libya, where there are “more than 300 kids waiting for open heart surgery, maybe 400.” Cardiac Alliance strives to maintain our collaboration with the hospital in Benghazi to care for these children in need.

Read the Reuters article to learn about the desperate need for sustainable healthcare in Libya.

With your support, we can continue our education programs to save more children in countries like Libya.