The World Heart Foundation _______________________ ______________________________

_________________________________________________

December 2006 ________________________________________________

- Executive Summary -

The World Heart Foundation

The World Heart Foundation was established in 1999 in Washington, DC as a non-profit organization with a mission to make cardiac surgery more accessible to patients in developing countries. Although there are over 30 humanitarian non-governmental organizations (NGO’s) and an additional 1,500 cardiac surgical teams (500 US and 1,000 Non-US) devoted solely 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, despite the laudable commitment of time, resources and effort and the obvious benefit to a relatively few patients, the ultimate impact of these groups and individual surgical teams on world-wide cardiac surgery is virtually negligible, with 93% of the world’s population still having no access to cardiac surgery.

To address this recalcitrant problem, the World Heart Foundation was established 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 website

was created and a Board of Directors, an International Advisory Board and a slate of Officers were established which together, include many of the world’s leading cardiac surgeons (Appendix A). The majority of these surgeons have had extensive experience in improving the quality and quantity of international cardiac surgery.

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GOAL I:DIRECT DELIVERY OF CARDIAC SURGERY

Twenty-seven (27) of the humanitarian NGO’s involved in the direct

delivery of cardiac surgery to developing countries are official Affiliate Organizations of the World Heart Foundation (Appendix B) In an effort to enhance the ability of these Affiliates to attain their own goals, certain centralized functions are provided by the World Heart Foundation, including the maintenance of a Volunteer Surgeon Database, an inventory of available equipment, a quality assurance program, limited coordination of the Affiliates’ international trips and educational programs, and the coordination of regional efforts by the Affiliates.

A major problem in the past is illustrated by the fact that in one year alone 7 different cardiac surgical teams visited Nicaragua for one week each without any of them knowing that the other teams had been there. The World Heart Foundation approach to this problem has been to establish Regional Surgical Hubs in specific sites within a general area of common heritage where cardiac surgery is already performed and then transfer patients 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-Child Foundation (Tel-Aviv), and the International Children’s Heart Hospital (Richmond, VA) established a Regional Surgical Hub in Barbados that serves the children of the Caribbean. The more complex cases are transferred to Dr. Aldo Castaneda’s clinic in Guatemala. This effort has already answered much of the need for cardiac surgery in Central America and in the Southern Caribbean basin and another Northern Caribbean Hub is currently being established in the Dominican Republic. Other World Heart Foundation Surgical Hubs have been founded in Mauritania, West Africa, and Mongolia and a new one is being established (in conjunction with WHF Affiliate, 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 to expand Heart-to-Heart’s successful St. Petersburg program into four other regions of Russia starting with Samara and Tomsk. These programs will be under the overall supervision of the central Russian system of 17 major cardiac surgery centers affiliated with the Bakulev Institute in Moscow. A similar program is currently under development in China to be administered

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through the services, personnel and extensive hospital network affiliated with Fu Wei Hospital in Beijing, the largest hospital in China. In addition to providing surgical teams to treat congenital heart problems, additional teams will be sent to China to teach the techniques for atrial fibrillation surgery and off-pump coronary bypass surgery. Within the next two years, a similar network 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 Heart Foundation, or the Foundation itself, cardiac surgery is now performed in over 75 of the world’s developing countries (Appendix C) and those efforts are 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 receive from visiting surgical teams is valuable, it is no substitute for a formal structured residency training program such as the ones that exist in the United States, Canada and some other Western countries. The World Heart Foundation is actively involved in the establishment of such programs in other countries, most notably China, where the first formal 6-year Cardiothoracic Surgery Residency Program was initiated in Shanghai on July 1, 2005. Dr. A. Thomas Pezzella, WHF Special Projects Director, was funded by the Chinese government and by the World Heart Foundation for one year which he spent in Shanghai to establish this inaugural training program. Dr. Pezzella will return to Shanghai every 6 months to oversee the development of the program. Additional overview is to be provided by organizations similar to the RRC for Thoracic Surgery, the American Board of Thoracic Surgery and the Thoracic Surgery Directors Association that will be established at the international level, primarily under the direction of Dr. Robert L. Replogle, a member of the World Heart Foundation Board of Directors.

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GOAL III:CONTINUING MEDICAL EDUCATION

Continuing medical education programs provide local surgeons with the knowledge to keep abreast of latest developments in the field of cardiothoracic surgery. Perhaps the major problem in the past has been that surgeons in developing countries simply do not have the resources to attend the numerous educational courses, conferences, symposia, surgical demonstrations, etc. that are offered in developed countries nor do they have access to the textbooks and specialty journals that keep Western surgeons abreast of the latest developments in cardiac surgery. In one instance, the World Heart Foundation actually photocopied an entire standard cardiac surgery textbook to distribute to a few surgeons in China who had no access to the original. Clearly, the internet has improved access to information but it is instructive to remember that: 1) less than 10% of the world’s population has access to a computer, and 2) most such services are not provided free of charge, e.g., online subscriptions to scientific journals and thus, to their articles.

Since 2000, The World Heart Foundation has produced numerous CME programs and international programs to enhance the exchange of information. Scientific educational programs have been held in seven different locales within the US and in several cities in Western Europe. An example of the benefit to foreign surgeons was a recent World Heart Foundation conference held in Paris in which live operative surgery was performed by three different surgeons generally recognized to be the experts in their fields. The World Heart Foundation and two of its Affiliate Organizations provided financial support to attend the meeting for 10 Professors of Cardiac Surgery from Eastern Europe and for cardiac surgeons from 17 African countries.

During three of the past four years, one of the major sessions at the Annual Meeting of the American Association for Thoracic Surgery has been the Global Initiatives Program held on Wednesday morning. The first two years that session, which centered on the types of initiatives that the World Heart Foundation and its Affiliate Organizations have promoted, was ranked number 1 by meeting attendees as the best session of the entire Annual Meeting.

Since 2002, the World Heart Foundation has held the International Cardiac Outreach Conference annually for the benefit of the WHF Affiliates and other interested parties. Last year, conference speakers included the directors of international cardiac services from the World Health

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Organization (WHO), Project Hope, UNICEF, the World Heart Federation, and many other prominent international organizations. The only other such international humanitarian conference has been the Global Forum on Humanitarian Medicine that has been held in Geneva bi-annually since 2003. In April 2006, an agreement was reached by the World Heart Foundation and the sponsors of the Geneva meeting to combine these two international 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 just been completed and will be donated to surgeons in developing countries free of charge. Future World Heart Foundation plans call for online video conferences and consultation services to be provided on its website which currently 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 is used by the humanitarian community of NGO’s and by the cardiac surgical community as the primary access port to keep abreast of the specialty’s humanitarian efforts and to interact with each other.

SUMMARY

During the past 5 years, many of the projects originally proposed by The World Heart Foundation have been initiated, though none have reached their full potential. The model of having The World Heart Foundation serve as an “enabler” for the activities of its Affiliates has worked well for the direct delivery of congenital heart surgery but needs to be expanded to include surgery for other pandemic adult heart conditions. The initiative undertaken by The World Heart Foundation in instituting formal residency training programs in developing countries is in its infancy and only time will tell whether any lasting impact will result from this initiative. Likewise, the establishment of a process for continuing medical education is in its earliest phases and it is the hope of The World Heart Foundation that our specialty organizations will become more formally engaged in these approaches to global health care and education.

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International Sites Served by the World Heart Foundation and Affiliates

International Sites Served by the World Heart Foundation and Affiliates

77 International Sites

Mexico, 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, South Africa, 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, South Korea, Tanzania, Gaza, Syria, Mali, Afghanistan

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Board of Directors

Hans 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

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Board of Directors

James 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.

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Board of Directors

Felix 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”.

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Officers

President and Chief Executive Officer

James L. Cox, M.D. – Naples, Florida

Executive Director

Donald C. Watson, M.D. – Memphis, Tennessee

During an academic career in pediatric cardiothoracic surgery, Dr. Watson developed an important appreciation for the impact of these services on the lives of individuals treated and trained by him. Experiences in non US environments accentuated a realization of the high demand for these services in regions of the world early in their economic development. After retirement from active practice, Dr. Watson has dedicated himself to improving the effectiveness of the delivery of these services by optimizing communication and information flow between similarly minded organizations. Building systems that allow

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organizations to become more effective and efficient in their efforts is a high priority. He is a Professor of Surgery and Pediatrics, a past Residency Program Director for Thoracic Surgery, and has served on numerous Boards.

Special Projects Director

A. Thomas Pezzella, M.D. – Worchester, Massachusetts

Through his monumental efforts to help children in underdeveloped countries over a career spanning 2 decades, Dr. Tom Pezzella is universally recognized as the most important and knowledgeable surgeon in America in this field. Though he maintains an active clinical practice, Dr. Pezzella has established hospitals and training programs all over the world and continues to sustain a “depot” of medical devices that he ships to strategic sites world-wide. Most recently, Dr. Pezzella lived for one year in Shanghai where he established the first formal six-year Cardiothoracic Surgery Residency Training Program in China. Dr. Pezzella is uniformly admired and respected by his peers for his unparalleled contributions to the surgical needs of developing countries and is uniquely qualified for his leadership role in the World Heart Foundation.

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International Advisory Board

Niv Ad, M.D.Director of Cardiovascular Research

Fairfax Cardiovascular InstituteFalls Church, Virginia

Cary Akins, M.D.Professor of Surgery

Massachusetts General HospitalHarvard School of Medicine

Boston, Massachusetts

Aldo Castaneda, M.D.Ladd Professor and Chief Emeritus

Boston Children’s HospitalHarvard School of Medicine

Boston, Massachusettsand

Past President, The American Association for Thoracic Surgery

Bum-Koo Cho, M.D.Emeritus Professor of Surgery and Director

The Yonsei Heart InstituteYonsei University School of Medicine

Seoul, KoreaAnd

Past President, The Asian Society of Cardiovascular Surgery

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Lawrence H. Cohn, M.D.Hubbard Professor and Chief

Former Chief, Division of Cardiac SurgeryBrigham & Women’s HosptialHarvard School of Medicine

Boston, Massachusettsand

Past President, The American Association for Thoracic Surgery

Delos M. Cosgrove, M.D.Chairman, Board of Governors

Formerly, Chairman of Cardiothoracic SurgeryThe Cleveland Clinic Foundation

Cleveland, Ohioand

Past President, The American Association for Thoracic Surgery

Fred A. Crawford, Jr., M.D.Horace G. Smithy Professor and Chairman

Department of SurgeryMedical University of South Carolina

Charleston, South Carolinaand

Past President, The American Association for Thoracic Surgery

Tirone E. David, M.D.Professor and Chief

Division of Cardiothoracic SurgeryToronto General Hospital

University of Toronto School of MedicineToronto, Ontario

andPast President, The American Association for

Thoracic Surgery

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L. Henry Edmunds, M.D.Professor and Chief Emeritus

Division of Cardiothoracic SurgeryUniversity of Pennsylvania School of Medicine

Philadelphia, Pennsylvaniaand

Editor, The Annals of Thoracic Surgery

Thomas B. Ferguson, M.D.Professor of Surgery Emeritus

Division of Cardiothoracic SurgeryBarnes Hospital at Washington University

School of MedicineSt. Louis, Missouri

andEditor, CTSNet

Past President, The American Association for Thoracic Surgery

Past President, The Society of Thoracic Surgeons

Timothy J. Gardner, M.D.Formerly Professor and Chief

Division of Cardiothoracic SurgeryUniversity of Pennsylvania School of Medicine

Philadelphia, Pennsylvaniaand

Past-President, The American Association for Thoracic Surgery

President, CTSNet

O. Wayne Isom, M.D.Professor and Chairman

Department of Cardiothoracic SurgeryThe New York Hospital

Cornell University School of MedicineNew York, New York

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Richard C. Jonas, M.D.Professor and Chief

Division of Pediatric Cardiac SurgeryChildrens Hospital

National Medical CenterWashington, DC

D. Craig Miller, M.D.Thelma and Henry Doelger Professor of Surgery

Director, Cardiovascular Surgery Physiology Research Laboratories

Department of Cardiothoracic SurgeryStanford University School of Medicine

Stanford, Californiaand

President-Elect, The American Association for Thoracic Surgery

John L. Ochsner, M.D.Professor and Chairman Emeritus

Department of SurgeryThe Alton S. Ochsner Foundation

New Orleans, Louisianaand

Past President, The American Association for Thoracic Surgery

Bruce A. Reitz, M.D.Professor and Chairman Emeritus

Department of Cardiothoracic SurgeryStanford University School of Medicine

Stanford, California

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Thomas L. Spray, M.D.Alice Langdon Warner Professor of SurgeryChief, Division of Pediatric Cardiac Surgery

Children’s Hospital of PhiladelphiaUniversity of Pennsylvania School of Medicine

Philadelphia, Pennsylvaniaand

Vice-President, The American Association for Thoracic Surgery

Jarda Stark, M.D.Professor and Chairman Emeritus

Department of Pediatric Cardiac SurgeryGreat Ormond Street Hospital for Sick Children

London, U.K.

Juro Wada, M.D.Executive Director

The International Society of Thoracic SurgeonsTokyo, Japan

Robert B. Wallace, M.D.Professor and Chairman Emeritus

Department of SurgeryGeorgetown University School of Medicine

Washington, D.C.and

Past President, The American Association for Thoracic Surgery

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Andrew S. Wechsler, M.D.

Stanley K. Brockman Professor of SurgeryChairman, Department of Cardiac Surgery

Hahnemann University HospitalDrexel University College of Medicine

Philadelphia, Pennsylvaniaand

Editor-in-Chief, Journal of Thoracic and Cardiovascular Surgery

Ralph J. Damiano, Jr., MD John Schoenberg Professor of Surgery

Chief, Section of Cardiac SurgeryDivision of Cardiothoracic Surgery

Washington University School of MedicineSt. Louis, Missouri

David H. Adams, MDMarie-Josee and Henry R. Kravis Professor of

SurgeryChairman, Department of Cardiothoracic

SurgeryMount Sinai Medical Center

New York, NY

Mehmet C. Oz, MDProfessor of Surgery

Director, Cardiovascular InstituteColumbia College of Physicians and Surgeons

New York-Presbyterian HospitalNew York, NY

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Jan M. Quaegebeur, MDProfessor of Surgery

Director, Pediatric Cardiac SurgeryColumbia University School of MedicineNew

York-Presbyterian HospitalNew York, NY

Francis Robicsek, MD, PhDChairman, Department of Thoracic and

Cardiovascular SurgeryDirector, Carolinas Heart InstituteCarolinas Medical CenterCharlotte, North Carolina

Harold C. Urschel, Jr., MDProfessor of Surgery

Baylor University Medical CenterDallas, Texas

andPast President, Society of Thoracic Surgeons

Not Pictured: Vincent Dor – Monte Carlo

Thomas Hougen – Washington

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