Heart specialist

Yorkhill children’s heart specialist warns thorough examination is unfair and puts unnecessary pressure on surgeons

A CHILDREN heart specialist warned yesterday that the official review of operations is putting pressure on desperate surgeons.

Andrew McLean spends his days caring for the broken hearts of Scotland’s sickest children and has operated on hundreds of critically ill babies and infants.

It is a task that would weigh heavily on the shoulders of most people.

But McLean, along with his colleagues, has helped halve the number of childhood heart surgery deaths over the past decade, despite an increase in the most complex cases. Now the surgeon, based at the Royal Hospital for Sick Children at Yorkhill in Glasgow, wants NHS bosses to rethink the ‘scrutiny’ facing 40 congenital heart surgeons across the UK.

Mr McLean said: “We are constantly anxious and believe the level of review is inappropriate.”

“No one is complacent, but we feel pressured and under siege.

“We operate on increasingly smaller and sicker babies and we are trying to solve heart problems at an earlier age.

“Surgeons are part of a team and the improvement in survival rates is not just due to surgery.

“There has also been an improvement in diagnosis, anesthesia and nursing care – all of which determine improved survival.

“The idea that I am trading better than 10 years ago is unlikely. I think I do them well, but the scrutiny is enormous.

Childhood heart surgery in the UK has been under intense scrutiny since the 1990s after high death rates were discovered at the Royal Bristol Infirmary.

Mandatory results reporting was introduced in 1997 and all specialist centers have submitted their data to the UK congenital heart audit since 2000. Although Mr McLean, 48, believes all surgeons should be required to accountable, he also wants the progress to be recognized.

He said: “It is not unfair to force us to meet a standard, but in most other areas that degree of control does not exist.

“If you have a child with cancer and he or she dies from it, people say that’s one of those things. It’s almost as if the logic is reversed.

“We are producing results that would have been considered incredibly good 20 years ago, but there has to be a certain degree of tolerance so that not everything can go well.”

About 15 years ago the decision was made to centralize pediatric congenital cardiology services in Glasgow.

This means that all of these surgeries are now being performed at Yorkhill, which will soon be relocating to the new Southern General campus. Four years ago, surgeons also took care of cases of hypoplastic left heart syndrome, where the left side of a baby’s heart does not form properly.

Mr McLean said: “This is the most difficult condition to treat and we have taken care of it.”

He, along with colleagues at University College London, recently published the results of an analysis of deaths within 30 days of childhood heart surgery.

It included a total of 36,641 operations between 2000 and 2010, of which 5,142 underwent two or more operations.

The figures showed that while the annual number of operations increased steadily from 2,283 in 2000 to 3,939 in 2009, the 30-day death rate fell from 4.3% to 2.6%.

Mr McLean said: “Rather than turning away higher risk patients at a time when outcomes were more closely monitored, a greater proportion of more complex patients have been taken care of in recent years.”

Now he thinks the focus should be on the longer-term needs of patients.

He said: “Children who survive can have longer term problems.

“Parents and patients told us this was important and we set out to measure these things. “

The Scottish Government has said: ‘It is right that cardiac surgeons are subjected to the type of rigorous examination in
place, which stems from an expert study published in 2001.

‘Of course all other areas of the NHS including other types of surgery are also under scrutiny to fully ensure patient safety and Scotland has one of the most important patient safety programs in the world. .

“The safety and sustainability of congenital cardiology services are paramount and that is why the National Services
The division is working to develop standards of care for people living with the disease in Scotland.

“Work to consider co-location of Congenital Heart Disease Services in Glasgow is ongoing and the National Specialized Services Committee will make recommendations to ministers in due course. “

Megan Fowles (left) and her twin sister Chelsea Fowles 6

“Our little Megan had her first heart operation when she was only three days old, but we knew the doctors would save her”

Laughing and joking with her twin sister, six-year-old Megan Fowles appears to be in good health.

But behind her bright smile hides a serious heart disease that the brave schoolgirl began battling even before she was born.

Her mother Denise, from Dennistoun, Glasgow, was 21 weeks pregnant when she learned the terrifying news that one of her babies had a rare heart defect – hypoplastic left heart syndrome – and could die.

HLHS means the left side of the heart is underdeveloped, leaving the heart unable to effectively pump blood throughout the body.

Megan and Chelsea were born at 35 weeks on October 22, 2008.

Megan was taken to the intensive care unit at Yorkhill Hospital before being transferred to Birmingham for life-saving surgery.

She was flown by air ambulance when she was only two days old. Denise, 38, and her partner Jason Stewart, 39,
followed by road.

Just three days old Megan Fowles (bottom) and her twin sister Chelsea in October 2008

Denise said: “We had to say goodbye to him. My heart was breaking. We exchanged blankets between the girls and exchanged their teddy bears.

“We were called on the way down and asked to consent to Megan’s procedure over the phone so she would have life-saving surgery while we were driving down. You don’t think you can do it, but you do.

The medical team was satisfied with their progress after the surgery. But she suffered cardiac arrest the night after her operation.

Denise said: “When we saw her after the operation, she didn’t look like our little girl. She was like a porcelain doll.

“We took Chelsea to the intensive care unit with us and they held hands. We took quite a few pictures because we thought Megan might not be able to.

“I’ve met people who blame surgeons when things go wrong, but it’s not their fault.

“We are very positive about our outlook and knew Megan would be fine.”

Over the years, Megan has had a number of operations and now undergoes regular checkups at Yorkhill.

Denise added, “We have been told that she will need a transplant when she is older. But she beat all the odds and we’re so proud of her.

One operation in particular that stays on Denise’s mind was when Megan’s chest was left open for medical reasons.

She said: “It was so scary. You just want your little girl to be even better.

The Yorkhill medical team holds a special place for the family. Some of the staff took care of Megan her whole life.

Denise said, “Megan is determined to be like everyone else. She plays with her sister and she does well in school.

“His condition is life-limiting, but we can’t dwell on that. It is there and it is the main thing.

“We are having fun and we would never want to restrict Megan in what she can do.”

In September, Megan takes part in the Yorkhill Children’s Charity sponsored walk to help other children like her. Anyone can register for the event at: www.yorkhill.org/events/our-events/yorkhill-sponsored-walk-2015

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