The AEPC in Europe.

Dr. András SzatmáriPresident AEPC

The „Rule”

• Professional need

• Institutional development

• Political acceptance

The „Rule”

Professional need

pediatric cardiology in the past

The Past• Rheumatic fever was the still the target

• Hardly any possibility for treatment of CHD

• Technology was still missing

• No interventional treatment availableuntil the „Rashkind procedure”(60’)

• Surgeons approached CHD differently

The Past• Almost everything, what the paediatric cardiologist did was

„pioneering”

• AEPC was founded by the pioneers ment, as a

„club of friends”

The „Rule”

• Professional need

• Institutional development

• Political acceptance

The „Rule”

Institutional development

the „past”

Links in the past

Paediatrics

Heart surgery

CardiologyPaediatric cardiology

AEPC

The „Rule”

• Professional need

• Institutional development

• Political acceptance

The „Rule”

Political acceptance ?

• Legal recognition

• Financing

(unless quality is appropriate and costs are reasonably low…)

The „Rule”

Professional need

pediatric cardiology at present

The Present• Rheumatic fever is almost disappeared in Europe

• Wide range of treatment possibilities for CHD

• Technology is booming, knowledge cummulates

• Specialization: „interventionalist”, „imaging people”, „arrhythmologist”, „fetal cardiologist” etc.

• Surgeons begin to approach CHD as a specialty

•„congenital heart surgeon”

The Present Data

• Numbers / facts ( 10 M inhabitants, 100 000 live births / y )

– CHD incidence ~ 1 % (900 - 1000 / y)– ~ 30-40 % requires treatment (300 – 400 / y)

• ~ 50 % (!) < 1 y age (150 -200 /y)

– Multi-stage treatment, „redo”: cummulation– Still small numbers !!– Number of cases quality : linear correlation

600-700 procedures / y / 10 M inhabitants

The Present

S p a i n P o r t u g a l

F r a n c e

I t a l y

G e r m a n y

I r e l a n d

M o r o c c o A l g e r i a T u n i s i a M a l t a

S e r b i a

C z e c h R e p .

P o l a n d N e t h .

L u x .

B e l g i u m

S w i t z . A u s t r i a H u n g a r y

R o m a n i a

B u l g a r i a

T u r k e y G r e e c e

A l b .

R u s s i a

F i n l a n d

S w e d e n

N o r w a y

G r e e n l a n d

I c e l a n d

F a r o e I s l a n d s

D e n m a r k

L i e c h .

( D e n m a r k )

( D e n m a r k ) J a n M a y e n

( N o r w a y )

E s t o n i a

L a t v i a

L i t h u a n i a

B e l a r u s

U k r a i n e

M o l d o v a

M o n a c o

S a n M a r i n o

R u s s i a

S l o v a k i a

U . K .

B o s . & H e r z .

M a c e .

M o n t .

S l o v e n i a

C r o a t i a

G r e e n l a n d S e a

N o r w e g i a n S e a

A t l a n t i c O c e a n

M e d i t e r r a n e a n S e a

E u r o p e

1 9 9 6 M A G E L L A N G e o g r a p h i x S M S a n t a B a r b a r a , C A 8 0 5 6 8 5 - 3 1 0 0

Surgery vs. catheter intervention

0

100

200

300

400

500

600

700

surgery 273 264 440 421 533 619 587 594 530 560 537

intervention 20 55 84 123 131 160 220 194 210 250 204

1985 …. 1994 … 1998 1999 2000 2001 2002 2003 2004 2005 2006

Surgery

0

200

400

600

800

opus 273 264 440 421 582 619 587 594 530 560 537

cpb 111 119 320 317 355 373 368 360 299 340 311

mortality 50 42 29 20 19 22 22 23 19 15 20

85 … 94 … 98 99 0 1 2 3 4 5200

6

The Present

• complexity of the patients increased

• patients survive and reach adult age

• number of „marker” cases is still limited : experience, quality

• Costs increase constantly

• need for improving quality

S p a i n P o r t u g a l

F r a n c e

I t a l y

G e r m a n y

I r e l a n d

M o r o c c o A l g e r i a T u n i s i a M a l t a

S e r b i a

C z e c h R e p .

P o l a n d N e t h .

L u x .

B e l g i u m

S w i t z . A u s t r i a H u n g a r y

R o m a n i a

B u l g a r i a

T u r k e y G r e e c e

A l b .

R u s s i a

F i n l a n d

S w e d e n

N o r w a y

G r e e n l a n d

I c e l a n d

F a r o e I s l a n d s

D e n m a r k

L i e c h .

( D e n m a r k )

( D e n m a r k ) J a n M a y e n

( N o r w a y )

E s t o n i a

L a t v i a

L i t h u a n i a

B e l a r u s

U k r a i n e

M o l d o v a

M o n a c o

S a n M a r i n o

R u s s i a

S l o v a k i a

U . K .

B o s . & H e r z .

M a c e .

M o n t .

S l o v e n i a

C r o a t i a

G r e e n l a n d S e a

N o r w e g i a n S e a

A t l a n t i c O c e a n

M e d i t e r r a n e a n S e a

E u r o p e

1 9 9 6 M A G E L L A N G e o g r a p h i x S M S a n t a B a r b a r a , C A 8 0 5 6 8 5 - 3 1 0 0

2 hours flight-time

International cooperation

The „Rule”

Institutional development

the „present”

Paediatric cardiology at present in Europe

AEPC worldwide is the only continentally (Europe)

organized association for paediatric cardiology.

AEPC - professional relations

Congenital cardiology

AEPC

Adult cardiology

ESC

ECHSA

CESP,EAP

EACTA

Intensive anaesthesiology

Heart surgery

Peadiatrics

EAE

EACTS

EHRAGUCH

STS

UEMS

The institutional representations

EU committee

ESC

CESP, IAPCardiology Section

AEPC

surgery

Council of HC Ministers

paediatricsGPs

National societies

The Present

AEPC is far more, than a „club of friends” today !

The Future• To achieve quality, concentration of material and human resources

are / will be required

• Closer cooperation among the involved professionals is / will be obligatory

• Re-arrangement of the professionals will occur!!

The Future

• Political acceptance

• CIVILIAN INITIATIVE AND SUPPORT ARE NEEDED !

Danke !