Pediatric Cardiac Services

Scope of Service

• Pediatric Cardiac Services was established at SKMC in 2007. Surgery for congenital heart disease (CHD) started in April 2007. Since its start to date, over 4500 Pediatric/congenital cardiac operations have been performed by our Team.
• Outcomes and results meet (in index cases exceed) the standards of international databases.
• Emirati nationals are represented at around 35% in our patient population that exceeds their percentage in the general population. This is a clear sign of acceptance of SKMC Pediatric Cardiac Surgery as the leading healthcare provider in the specialty.
• Currently, about a 25-33% of our surgical patients receive treatment by the ABM scheme. UAE Government is praised for providing treatment for CHD patients and families; this is unparalleled extremely generous sponsorship in this nationwide program.
• Entire spectrum of Pediatric cardiothoracic surgical modalities is offered (with the exception of Pediatric heart transplantation and long-term mechanical circulatory support): open-heart repairs from neonatal age to adult-congenital cardiac (GUCH) age-group; our Service is the only comprehensive possibility for neonatal/Pediatric ECMO, for GUCH, hybrid procedures:
• Inpatient service: assessment and surgical management of all congenital cardiac anomalies from neonatal age to grown up congenital heart (GUCH) disease.
• Outpatient care: assessment and surgical management of all congenital cardiac anomalies from neonatal age to grown up congenital heart (GUCH) disease.
• All advanced surgical procedures are performed on a regular basis: 
  • Pediatric Cardiac Surgery team provides 24/7, two-tier on-call coverage for cardiac surgical emergencies (including cannulation for cardiac/respiratory ECMO), out-of-hours surgical procedures, consultation and decision-making in perioperative patient management.
  • 24/7 coverage for ER consultations on cardiothoracic surgical, blunt/penetrating chest trauma emergencies.
  • Remote Pediatric cardiac surgical input in perioperative decision-making and planning for other SEHA facilities via CERNER-uploaded echocardiographic, imaging and other clinical data, etc.
  • Nation-wide (tertiary-quaternary level) referral center for Pediatric cardiac surgery care, from SEHA and non-SEHA facilities, including multidisciplinary review and decision-making
  • Contribution and participation in emerging therapeutic modalities of hybrid cardiac surgery, 3D printing. 

Service Settings

Inpatient Service

Pediatric Cardiac Surgery is a super-specialty that provides its care in the settings of multidisciplinary team-work in open cooperation and communication with the allied services of: 

• Pediatric Cardiology: preoperative/postoperative Pediatric Wards, High Dependency Unit, Clinic consultations, ER admissions
  • Critical Care: Pediatric Cardiac Intensive Care Unit, physicians and nursing, allied technicians
  • Operating Room Department: Cardiac Surgical Nurses
  • Department of Anesthesia: Cardiac Anesthesia team, physicians and technicians
  • Cooperation with other surgical disciplines of ENT, Pediatric Surgery in patient co-management
  • Cardiac Perfusion Team: extracorporeal circulation during open-heart surgery; extracorporeal membrane oxygenation (ECMO) as short-medium-term circulatory support for cardiac and respiratory emergencies for Pediatric 
  • Cath lab Team: in co-management of patients undergoing hybrid procedures, requiring surgical input/participation
  • Corniche Hospital and other hospitals in 150km area for round-trip premi-PDA ligations

Outpatient Service

• Clinic Hours: no fixed hours. Clinics are provided by demand of patients/families.
  • Clinics: Please refer above to current scope of service

Model of Care

Pediatric cardiac surgery is a super-specialty that treats limited number of patients at very high level with significant resource and workforce utilization. Therefore, Pediatric cardiac surgery is best suited in the format of a specialty hospital with other tertiary-care services (in contrast to a general hospital which sees a large number of patient encounters at a relatively low level and with much less expenditure). 

Worldwide, Pediatric cardiac surgery programs can exploit their best performance in the following settings:

1. In academic/university Pediatric hospitals, e.g. Boston Children’s, Great Ormond Street Hospital in London, Melbourne Children’s Hospital, etc. – Pediatric cardiac services enjoy a great level of independence at these hospitals in recognition of their special needs and characteristics
2. As a national Pediatric cardiac center, e.g. Children’s National in Washington, Pediatric Cardiac Center in Seoul, etc. These units bring all subspecialties under one organizational umbrella. They work along strict departmental guidelines, have strict working routines (which are quite dissimilar from other Pediatric specialties), strong academic leaderships. National Pediatric/congenital cardiac centers can ensure the best patient outcomes, as they function along international benchmarks and quality criteria. They also offer educational and research faculties and are the Center of Excellence in the profession. UAE being a pioneer in development of quality of healthcare, spearheading innovations, and having a growing young population definitely deserves the establishment of the UAE National Centre for Congenital Heart Disease. We propose that the new Pediatric Hospital embraces the idea of having a Center of Excellence in its organization structure.

Service Expansion Plan

ECMO (cardiac and respiratory). Our extracorporeal circulatory support program started in 2009 and has become a largest program in its kind in the country. There are around 15 ECMO runs at SKMC annually. Survival to decannulation (65-75%), and survival to discharge (58%) is at par level with international databases. ECMO is now predominantly offered for cardiac patients. Respiratory patients are evaluated on an individual basis. Officially, the program is not yet open for systematic acceptance of patients for respiratory support. Additional beds, personnel and financial recognition of extra work should be allocated to a start of that new service modality. Specialized transport of patients should be organized, too. Based on the data of birth rate, prevalence of conditions e.g. IRDS, congenital diaphragmatic hernia, etc. it is assumed that respiratory ECMO may be necessary in 15-20 cases on a yearly basis (in addition to existing caseload). We propose that additional 5 beds will be needed for the reception and treatment of ECMO patients, 4 ECMO physicians and 12 ECMO Specialist nurses will be needed to arrange transport (i.e. ECMO-retrieval service), and in-house treatment. Additional equipment of 4 ECMO-pumps and consumables will be necessary too. 

Hybrid program. SKMC Pediatric Cardiac Surgery has been pioneering hybrid cardiac surgery between 2009 and 2011. This project has been the very first in its kind in the region. We then officially submitted a business proposal for establishing a hybrid OR. This plan was not realized for financial reasons. Most new private hospitals (CCAD, Burjeel Hospital, etc.) in Abu Dhabi offer this treatment modality and it is strongly proposed that SKMC should follow their example. A hybrid OR would allow the capabilities of a full cardiac OR (including extracorporeal circulation) as well as imaging modalities, e.g. biplane angiography and cardiac catheters, TEE and –preferably- CT-Angio and cardiac MRI. The facility could be utilized by not only Pediatric cardiac surgery, interventional radiology, vascular-, neurosurgery, etc. 

Pediatric cardiac surgery envisages to bring 100-150 procedures into the hybrid OR annually. Besides, hybrid-1 for selected stage-1 patient (cca. 15-20 procedures/year), hybrid intracardiac defect closures (approx. 40-50 cases); all our patients with staging procedure (e.g. BDG, Fontan operations) would be performed therein (approx. 75-100 procedures/year). The rest of the sessions could be subscribed by allied disciplines (e.g. IR, neurosurgery, orthopedics, etc.). 

Establishment of a hybrid OR at SKMC needs constructional work, purchase of new equipment that is a major project financially. We refer to our previous proposals for the details. This project should be realized within 2 years, otherwise SKMC lose her market-leading position and our clinical team will not be able to guarantee the best contemporary modalities and outcomes.

Mechanical circulatory support and cardiac transplantation program. There is a growing Pediatric and adolescent patient population in the United Arab Emirates with end-stage heart failure. We estimate an incidence growth by 5 -7 patients/year. It is noted that the true incidence is unknown as those patients –for the lack of opportunity for cure- are traditionally underreported. Pertinent UAE law has now redefined conditions of the end of life so that a legal framework for permitting cardiac transplantation has been worked out. As cardiac transplantation (both Pediatric and GUCH) will be a major new project for the entire country, it is important that SKMC (a leading tertiary-quaternary center) should take leadership in preparatory work as well as to perform this modality. Scientific and organizational basis could be worked out with existing transplantation programs at SKMC and CCAD as well as in close cooperation with a network of professionals all over the country. We propose, Pediatric/GUCH cardiac transplantation project could be realized within 18 months. One of the pillars of cardiac transplantation is the availability of a long-term circulatory support program. (Please, note that ECMO is only available in short-medium term, maximum 6 weeks.) Cardiac transplantation will require 2 additional transplant cardiac surgeons (for organ retrieval and transport), 3 transplant cardiologists, a specialist team of coordinators, support team, histopathologist, internist, etc. Based on the population-demographics of the UAE, it is envisaged that cardiac transplantation may be necessary in 15-20 cases/year; it is assumed that almost 66% of the recipients will be among Pediatric-adolescent age groups. Financial aspects of that project consist of purchasing long-term circularity support machines (e.g. Berlin-heart), new equipment to detect early and chronic rejection, immunosuppressive medication, etc. 

Grown-up congenital heart surgery. As premised this patient population is underrepresented in our surgical group. Emirati patients had been operated overseas typically return to their original treatment center for further intervention and surgery. Non-nationals with previously operated CHD typically present in lower prevalence in the UAE for being absent in the workforce. Almost 3000 CHD patients operated on by our Service will reach adolescent age in the coming years. It is expected that organized coverage for GUCH patients is being established. GUCH multidisciplinary team consists of congenital cardiac surgeons, GUCH cardiologists, representatives of specialized disciplines, etc. Our Team already has necessary surgical expertise. It is proposed that 1-2 surgical sessions/week will be necessary to cover the needs of the UAE (=approx. 100 GUCH-operation/year). Similarly, a GUCH Clinic should be set up 1 day/week. 

Organized research and education/training. It is envisaged that SKMC Pediatric Cardiac Surgery will grow into a regional key provider in our Specialty. Our program is already a market-leader on a national level. SKMC has a medium-sized program that has all the potentials to grow into a large clinical center. Research, training and education distinguishes large centers from medium-sized ones. It is imperative that SKMC should take leadership in all of these activities. Strong academic leadership is proposed. Author of this proposal (Dr. Kiraly) is equipped with an academic degree (Ph.D.) and is willing to develop research and education. Working relationship with New York University Abu Dhabi has already been established; joint appointments (e.g. Associate Professorship) at Khalifa University/Al Ain University could help our participation in Arab Board training for surgical residents.