The World Heart Foundation ______________________________________________________________________________________________________ December 2006 ________________________________________________
2 - Executive Summary - The World Heart Foundation The World Heart Foundation was established in 1999 inWashington, DC as a non-profit organization with a mission to make cardiacsurgery more accessible to patients in developing countries. Although thereare over 30 humanitarian non-governmental organizations (NGO’s) and anadditional 1,500 cardiac surgical teams (500 US and 1,000 Non-US) devotedsolely to this same goal, there has been no coordination among the NGO’s,among the surgeons, or between the NGO’s and the surgeons. Thus, despitethe laudable commitment of time, resources and effort and the obviousbenefit to a relatively few patients, the ultimate impact of these groups andindividual surgical teams on world-wide cardiac surgery is virtuallynegligible, with 93% of the world’s population still having no access tocardiac surgery. To address this recalcitrant problem, the World Heart Foundation wasestablished with the specific goals of: 1. enhancing the direct delivery of cardiac surgery by providing structure, organization and expertise to the existing activities of NGO’s and of individual cardiac surgical teams, 2. improving the expertise and number of local surgeons by establishing formal cardiac surgery residency training programs in the developing countries, and 3. providing for the continuing medical education of local surgeons by utilizing modern electronic teaching and education techniques. To facilitate these specific goals, a World Heart Foundation websitewas created and a Board of Directors, an International Advisory Board and aslate of Officers were established which together, include many of theworld’s leading cardiac surgeons (Appendix A). The majority of thesesurgeons have had extensive experience in improving the quality andquantity of international cardiac surgery.
3 GOAL I: DIRECT DELIVERY OF CARDIAC SURGERY Twenty-seven (27) of the humanitarian NGO’s involved in the directdelivery of cardiac surgery to developing countries are official AffiliateOrganizations of the World Heart Foundation (Appendix B) In an effort toenhance the ability of these Affiliates to attain their own goals, certaincentralized functions are provided by the World Heart Foundation, includingthe maintenance of a Volunteer Surgeon Database, an inventory of availableequipment, a quality assurance program, limited coordination of theAffiliates’ international trips and educational programs, and the coordinationof regional efforts by the Affiliates. A major problem in the past is illustrated by the fact that in one yearalone 7 different cardiac surgical teams visited Nicaragua for one week eachwithout any of them knowing that the other teams had been there. TheWorld Heart Foundation approach to this problem has been to establishRegional Surgical Hubs in specific sites within a general area of commonheritage where cardiac surgery is already performed and then transferpatients from within that region to the WHF Surgical Hub. As one example,under the direction of the World Heart Foundation, three of the Affiliates,the International Children’s Heart Fund (Worchester, MA), the Save-a-ChildFoundation (Tel-Aviv), and the International Children’s Heart Hospital(Richmond, VA) established a Regional Surgical Hub in Barbados thatserves the children of the Caribbean. The more complex cases aretransferred to Dr. Aldo Castaneda’s clinic in Guatemala. This effort hasalready answered much of the need for cardiac surgery in Central Americaand in the Southern Caribbean basin and another Northern Caribbean Hub iscurrently being established in the Dominican Republic. Other World HeartFoundation Surgical Hubs have been founded in Mauritania, West Africa,and Mongolia and a new one is being established (in conjunction with WHFAffiliate, East Meets West) in Hue, Vietnam. The World Heart Foundation has worked with another Affiliate,Heart-to-Heart (Oakland, CA) and the medical authorities in Moscow toexpand Heart-to-Heart’s successful St. Petersburg program into four otherregions of Russia starting with Samara and Tomsk. These programs will beunder the overall supervision of the central Russian system of 17 majorcardiac surgery centers affiliated with the Bakulev Institute in Moscow. Asimilar program is currently under development in China to be administered
4through the services, personnel and extensive hospital network affiliatedwith Fu Wei Hospital in Beijing, the largest hospital in China. In addition toproviding surgical teams to treat congenital heart problems, additional teamswill be sent to China to teach the techniques for atrial fibrillation surgery andoff-pump coronary bypass surgery. Within the next two years, a similarnetwork is planned for India, again utilizing the in-country resources,personnel and network affiliations. Through the efforts of the World Heart Foundation Affiliates,individual surgical teams directly affiliated with the World HeartFoundation, or the Foundation itself, cardiac surgery is now performed inover 75 of the world’s developing countries (Appendix C) and those effortsare far more coordinated and organized than at any previous time. GOAL II: CARDIAC SURGERY RESIDENCY TRAINING PROGRAMS Although the “preceptorship” type training that local surgeons receivefrom visiting surgical teams is valuable, it is no substitute for a formalstructured residency training program such as the ones that exist in theUnited States, Canada and some other Western countries. The World HeartFoundation is actively involved in the establishment of such programs inother countries, most notably China, where the first formal 6-yearCardiothoracic Surgery Residency Program was initiated in Shanghai onJuly 1, 2005. Dr. A. Thomas Pezzella, WHF Special Projects Director, wasfunded by the Chinese government and by the World Heart Foundation forone year which he spent in Shanghai to establish this inaugural trainingprogram. Dr. Pezzella will return to Shanghai every 6 months to oversee thedevelopment of the program. Additional overview is to be provided byorganizations similar to the RRC for Thoracic Surgery, the American Boardof Thoracic Surgery and the Thoracic Surgery Directors Association thatwill be established at the international level, primarily under the direction ofDr. Robert L. Replogle, a member of the World Heart Foundation Board ofDirectors.
5 GOAL III: CONTINUING MEDICAL EDUCATION Continuing medical education programs provide local surgeons withthe knowledge to keep abreast of latest developments in the field ofcardiothoracic surgery. Perhaps the major problem in the past has been thatsurgeons in developing countries simply do not have the resources to attendthe numerous educational courses, conferences, symposia, surgicaldemonstrations, etc. that are offered in developed countries nor do they haveaccess to the textbooks and specialty journals that keep Western surgeonsabreast of the latest developments in cardiac surgery. In one instance, theWorld Heart Foundation actually photocopied an entire standard cardiacsurgery textbook to distribute to a few surgeons in China who had no accessto the original. Clearly, the internet has improved access to information butit is instructive to remember that: 1) less than 10% of the world’s populationhas access to a computer, and 2) most such services are not provided free ofcharge, e.g., online subscriptions to scientific journals and thus, to theirarticles. Since 2000, The World Heart Foundation has produced numerousCME programs and international programs to enhance the exchange ofinformation. Scientific educational programs have been held in sevendifferent locales within the US and in several cities in Western Europe. Anexample of the benefit to foreign surgeons was a recent World HeartFoundation conference held in Paris in which live operative surgery wasperformed by three different surgeons generally recognized to be the expertsin their fields. The World Heart Foundation and two of its AffiliateOrganizations provided financial support to attend the meeting for 10Professors of Cardiac Surgery from Eastern Europe and for cardiac surgeonsfrom 17 African countries. During three of the past four years, one of the major sessions at theAnnual Meeting of the American Association for Thoracic Surgery has beenthe Global Initiatives Program held on Wednesday morning. The first twoyears that session, which centered on the types of initiatives that the WorldHeart Foundation and its Affiliate Organizations have promoted, was rankednumber 1 by meeting attendees as the best session of the entire AnnualMeeting. Since 2002, the World Heart Foundation has held the InternationalCardiac Outreach Conference annually for the benefit of the WHF Affiliatesand other interested parties. Last year, conference speakers included thedirectors of international cardiac services from the World Health
6Organization (WHO), Project Hope, UNICEF, the World Heart Federation,and many other prominent international organizations. The only other suchinternational humanitarian conference has been the Global Forum onHumanitarian Medicine that has been held in Geneva bi-annually since2003. In April 2006, an agreement was reached by the World HeartFoundation and the sponsors of the Geneva meeting to combine these twointernational conferences into a single Global Forum to be held annually,alternating between Geneva and Washington, DC. Finally, a series of 16 one-hour lectures on cardiac surgery have justbeen completed and will be donated to surgeons in developing countries freeof charge. Future World Heart Foundation plans call for online videoconferences and consultation services to be provided on its website whichcurrently receives approximately 25,000 “hits” per month. The website(www.world-heart.org) has been designed, developed and managed by Dr.Donald C. Watson, Executive Director of the World Heart Foundation. It isused by the humanitarian community of NGO’s and by the cardiac surgicalcommunity as the primary access port to keep abreast of the specialty’shumanitarian efforts and to interact with each other. SUMMARY During the past 5 years, many of the projects originally proposed byThe World Heart Foundation have been initiated, though none have reachedtheir full potential. The model of having The World Heart Foundation serveas an “enabler” for the activities of its Affiliates has worked well for thedirect delivery of congenital heart surgery but needs to be expanded toinclude surgery for other pandemic adult heart conditions. The initiativeundertaken by The World Heart Foundation in instituting formal residencytraining programs in developing countries is in its infancy and only time willtell whether any lasting impact will result from this initiative. Likewise, theestablishment of a process for continuing medical education is in its earliestphases and it is the hope of The World Heart Foundation that our specialtyorganizations will become more formally engaged in these approaches toglobal health care and education.
7 International Sites Served by the International Sites Served by the World Heart Foundation and Affiliates World Heart Foundation and Affiliates 77 International SitesMexico, Guatemala, Costa Rico, Nicaragua, El Salvador, Albania, Bolivia, Croatia,Dominican Republic, Egypt, Haiti, Honduras, Iran, Iraq, Jordan, Jamaica, Pakistan,Palestine, Peru, Ukraine, Antigua, Barbuda, Guyana, Trinidad & Tobago, SouthAfrica, Columbia, India, China (3 sites), Kenya, Malaysia, Morocco, Georgia,Lebanon, Mozambique, Mauritius, Eritrea, Vietnam (3 sites), Mauritania, Sudan,Chile, Venezuela, Russia (3 sites), Armenia, Ecuador, Bangladesh, Thailand, Brazil,Cambodia, Belize, Nigeria, Cameroon, Kosovo, St. Vincent, Belarus, Yugoslavia,Bosnia, Kazakhstan, Usbekistan, Ethiopia, Grenada, Hungary, Ivory Coast, Liberia,Lithuania, Mongolia, Nepal, Panama, Philippines, Poland, Romania, Senegal, SouthKorea, Tanzania, Gaza, Syria, Mali, Afghanistan Board of Directors
8Hans G. Borst, M.D. – Munich, Germany Dr. Borst is the retired Professor and Chairman of the Department of Cardiothoracic Surgery at the University of Hannover in Germany. He is best known for his development of surgical procedures for the treatment of thoracic aortic disorders, most notably as the creator of the “Elephant Trunk” Procedure. Dr. Borst has trained many of the leading cardiothoracic surgeons in Europe, Asia and America. Since his retirement, he has returned to his hometown of Munich where he has become extremely active in humanitarian activities directed at treating heart disease in the children of Eastern Europe. Dr. Borst is a Past President of the European Association of Cardiothoracic Surgeons (EACTS) and is now the Chairman of that organization’s Eastern European Committee. In June, 2000, Dr. Borst was honored in Paris, France as one of only thirty “Pioneers in Cardiothoracic Surgery for the First 50 Years of the Specialty”.Alain F. Carpentier, M.D., PhD. – Paris, France Dr. Carpentier is the Professor and Chairman of the Department of Cardiothoracic Surgery at the University of Paris and the Hopital Europeen Georges Pompidou in Paris, France. His contributions in the areas of artificial aortic and mitral tissue valves, mitral valve repair, and most other areas of cardiac surgery, including most recently, robotic techniques are truly legendary. In addition to being a virtuoso pianist, Dr. Carpentier is perhaps the greatest surgical philanthropist in history, having donated virtually all of the proceeds from his numerous and extremely lucrative device patents to the establishment of a very successful hospital in Vietnam which he founded in 1992. In June, 2000, Dr. Carpentier was honored in Paris, France as one of only thirty “Pioneers in Cardiothoracic Surgery for the First 50 Years of the Specialty Board of Directors
9James L. Cox, M.D. – Naples, Florida Dr. Cox, is the Emeritus Evarts A. Graham Professor of Surgery and Former Chief of the Division of Cardiothoracic Surgery at Washington University School of Medicine and Barnes Hospital in St. Louis, Missouri. He has been President of the American Association for Thoracic Surgery, Editor of two AATS journals, Chairman of the Residency Review Committee for Thoracic Surgery, a Director of the American Board of Thoracic Surgery, on the Board of Directors of CTSNet and of the Thoracic Foundation for Research and Education. Dr. Cox is best known for his work in the field of cardiac arrhythmia surgery and the development of the Cox- Maze Procedure for the treatment of atrial fibrillation. In June 2000, Dr. Cox was honored in Paris, France as one of the thirty “Pioneers in Cardiothoracic Surgery for the First 50 Years of the Specialty”. In May 2005, Dr. Cox became only the second American cardiac surgeon ever elected to the Russian Academy of Medical Sciences.Robert L. Replogle, M.D. – Chicago, Illinois Dr. Replogle is a pediatric cardiac surgeon who has been associated with the University of Chicago throughout most of his career. Easily his greatest contribution has been his unwavering and indefatigable pursuit of the establishment of a viable website for the entire specialty of Thoracic Surgery, the CTSNet. As a result of his sometimes lonely efforts, the CTSNet rapidly became one of the most important and valuable tools in Thoracic Surgery, receiving over 10 million “hits” per month. Dr. Replogle was the first Executive Director of the CTSNet, a most deserving position. He is also a Past President of The Society of Thoracic Surgeons. His major initiatives are presently directed towards the establishment of formal international training programs in cardiothoracic surgery. Board of Directors
10Felix Unger, M.D. – Salzburg, Austria Dr. Unger is the Professor and Chairman of Cardiothoracic Surgery in Salzburg, Austria. He also chairs the European Heart Institute, a conglomerate of the Academies of Science of the member countries of the European Common Market. Dr. Unger serves as the Editor of Pathophysiologic Cardiovascular Surgery, the official journal of the European Heart Institute, the International Society of Thoracic Surgery, and the World Heart Foundation. Dr. Unger is responsible for the most complete world-wide survey ever performed to document the disparity of available cardiac surgery in developed versus underdeveloped countries.Sir Magdi Yacoub, M.D. – London, U.K. Sir Magdi is the retired Professor and Chairman of the Brompton Hospital - National Heart Institute and of the Harefield Hospital System in London. His work ethic and surgical prowess are legendary and his contributions cover the entire gamut of Thoracic Surgery. Sir Magdi’s monumental achievements in our specialty led to his being Knighted by Queen Elizabeth II. In March, 2002 following his retirement, he was tapped personally by Prime Minister Tony Blair to be the focal point for the recruitment of other world-class physicians and surgeons into the British National Health Service. In June, 2000, Dr. Yacoub was honored in Paris, France as one of only thirty “Pioneers in Cardiothoracic Surgery for the First 50 Years of the Specialty”. Officers
11 President and Chief Executive Officer James L. Cox, M.D. – Naples, Florida Executive Director Donald C. Watson, M.D. – Memphis, TennesseeDuring an academic career in pediatric cardiothoracic surgery, Dr. Watson developed animportant appreciation for the impact of these services on the lives of individuals treatedand trained by him. Experiences in non US environments accentuated a realization of thehigh demand for these services in regions of the world early in their economicdevelopment. After retirement from active practice, Dr. Watson has dedicated himself toimproving the effectiveness of the delivery of these services by optimizing communicationand information flow between similarly minded organizations. Building systems that alloworganizations to become more effective and efficient in their efforts is a high priority. He isa Professor of Surgery and Pediatrics, a past Residency Program Director for ThoracicSurgery, and has served on numerous Boards.
12 Special Projects Director A. Thomas Pezzella, M.D. – Worchester, MassachusettsThrough his monumental efforts to help children in underdeveloped countries over acareer spanning 2 decades, Dr. Tom Pezzella is universally recognized as the mostimportant and knowledgeable surgeon in America in this field. Though he maintains anactive clinical practice, Dr. Pezzella has established hospitals and training programs allover the world and continues to sustain a “depot” of medical devices that he ships tostrategic sites world-wide. Most recently, Dr. Pezzella lived for one year in Shanghaiwhere he established the first formal six-year Cardiothoracic Surgery Residency TrainingProgram in China. Dr. Pezzella is uniformly admired and respected by his peers for hisunparalleled contributions to the surgical needs of developing countries and is uniquelyqualified for his leadership role in the World Heart Foundation. International Advisory Board
13 Aldo Castaneda, M.D. Ladd Professor and Chief Emeritus Boston Children’s Hospital Harvard School of Medicine Niv Ad, M.D. Boston, MassachusettsDirector of Cardiovascular Research and Fairfax Cardiovascular Institute Past President, The American Association for Falls Church, Virginia Thoracic Surgery Bum-Koo Cho, M.D. Emeritus Professor of Surgery and Director The Yonsei Heart Institute Yonsei University School of Medicine Cary Akins, M.D. Seoul, Korea Professor of Surgery And Massachusetts General Hospital Past President, The Asian Society of Harvard School of Medicine Cardiovascular Surgery Boston, Massachusetts
14 Lawrence H. Cohn, M.D. Fred A. Crawford, Jr., M.D. Hubbard Professor and Chief Horace G. Smithy Professor and Chairman Former Chief, Division of Cardiac Surgery Department of Surgery Brigham & Women’s Hosptial Medical University of South Carolina Harvard School of Medicine Charleston, South Carolina Boston, Massachusetts and and Past President, The American Association forPast President, The American Association for Thoracic Surgery Thoracic Surgery Delos M. Cosgrove, M.D. Tirone E. David, M.D. Chairman, Board of Governors Professor and ChiefFormerly, Chairman of Cardiothoracic Surgery Division of Cardiothoracic Surgery The Cleveland Clinic Foundation Toronto General Hospital Cleveland, Ohio University of Toronto School of Medicine and Toronto, Ontario Past President, The American Association for and Thoracic Surgery Past President, The American Association for Thoracic Surgery
15 Timothy J. Gardner, M.D. L. Henry Edmunds, M.D. Formerly Professor and Chief Professor and Chief Emeritus Division of Cardiothoracic Surgery Division of Cardiothoracic Surgery University of Pennsylvania School of MedicineUniversity of Pennsylvania School of Medicine Philadelphia, Pennsylvania Philadelphia, Pennsylvania and and Past-President, The American Association for Editor, The Annals of Thoracic Surgery Thoracic Surgery President, CTSNet Thomas B. Ferguson, M.D. O. Wayne Isom, M.D. Professor of Surgery Emeritus Professor and Chairman Division of Cardiothoracic Surgery Department of Cardiothoracic Surgery Barnes Hospital at Washington University The New York Hospital School of Medicine Cornell University School of Medicine St. Louis, Missouri New York, New York and Editor, CTSNetPast President, The American Association for Thoracic Surgery Past President, The Society of Thoracic Surgeons
16 Richard C. Jonas, M.D. John L. Ochsner, M.D. Professor and Chief Professor and Chairman Emeritus Division of Pediatric Cardiac Surgery Department of Surgery Childrens Hospital The Alton S. Ochsner Foundation National Medical Center New Orleans, Louisiana Washington, DC and Past President, The American Association for Thoracic Surgery D. Craig Miller, M.D. Bruce A. Reitz, M.D.Thelma and Henry Doelger Professor of Surgery Professor and Chairman Emeritus Director, Cardiovascular Surgery Physiology Department of Cardiothoracic Surgery Research Laboratories Stanford University School of Medicine Department of Cardiothoracic Surgery Stanford, California Stanford University School of Medicine Stanford, California and President-Elect, The American Association for Thoracic Surgery
17 Juro Wada, M.D. Thomas L. Spray, M.D. Executive Director Alice Langdon Warner Professor of Surgery The International Society of Thoracic Surgeons Chief, Division of Pediatric Cardiac Surgery Tokyo, Japan Children’s Hospital of PhiladelphiaUniversity of Pennsylvania School of Medicine Philadelphia, Pennsylvania andVice-President, The American Association for Thoracic Surgery Robert B. Wallace, M.D. Jarda Stark, M.D. Professor and Chairman Emeritus Professor and Chairman Emeritus Department of Surgery Department of Pediatric Cardiac Surgery Georgetown University School of MedicineGreat Ormond Street Hospital for Sick Children Washington, D.C. London, U.K. and Past President, The American Association for Thoracic Surgery
18 Chairman, Department of Cardiothoracic Andrew S. Wechsler, M.D. Surgery Stanley K. Brockman Professor of Surgery Mount Sinai Medical Center Chairman, Department of Cardiac Surgery New York, NY Hahnemann University Hospital Drexel University College of Medicine Philadelphia, Pennsylvania and Editor-in-Chief, Journal of Thoracic and Cardiovascular Surgery Mehmet C. Oz, MD Professor of Surgery Director, Cardiovascular Institute Columbia College of Physicians and Surgeons Ralph J. Damiano, Jr., MD New York-Presbyterian Hospital John Schoenberg Professor of Surgery New York, NY Chief, Section of Cardiac Surgery Division of Cardiothoracic Surgery Washington University School of Medicine St. Louis, Missouri David H. Adams, MDMarie-Josee and Henry R. Kravis Professor of Surgery
19 Jan M. Quaegebeur, MD Professor of Surgery Director, Pediatric Cardiac Surgery Columbia University School of MedicineNew York-Presbyterian Hospital Francis Robicsek, MD, PhD New York, NY Chairman, Department of Thoracic and Cardiovascular Surgery Director, Carolinas Heart Institute Carolinas Medical Center Charlotte, North Carolina Harold C. Urschel, Jr., MD Professor of Surgery Baylor University Medical Center Dallas, Texas and Past President, Society of Thoracic SurgeonsNot Pictured: Vincent Dor – Monte Carlo Thomas Hougen – Washington