Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 5 - Health Planning
Chapter 115 - Health Resource requirements
Subchapter B - Facility or Service-Specific Criteria and Standards
Section I-11511 - Open Heart Surgery

1. Open heart surgery is the generic term for various surgical operations performed on the heart or major arteries of the heart. Open heart surgery procedures are defined as those which use a heart-lung bypass machine to perform the function of circulation during surgery.

2. The Inter-Society Commission on Heart Diseases Resources reports that there are over 1,000,000 deaths in the United States each year due to diseases of the heart and coronary arteries. A wide range of congenital and acquired disease and defects of the heart (and allied vessels) can be rectified with open heart surgery. This sophisticated procedure is used to preserve life and to improve the quality of life by repairing or replacing damaged portions of the heart and blood vessels to prevent the development of more serious problems, and to reduce disability.

3. Open heart surgery procedures, adult and pediatric, require costly, highly specialized personnel and facility resources, and supportive intensive care and cardiac care units. The total bill for open heart surgery can exceed $150,000. Thus, efforts should be made to limit unnecessary duplication of related resources.

4. Adult open heart surgical programs should have the capability of performing a full range of procedures, including but not limited to, the following: repair/replacement of heart valves: repair of congenital defects; cardiac revascularization; repair/reconstruction of intra-thoracic vessels; and treatment of cardiac trauma.

5. Open heart surgical programs should have the ability to implement and apply circulatory assist devices such as intra-aortic balloon, prolonged cardiopulmonary partial bypass, and a full range of diagnostic and support system services. Some of the services provided are cardiology, hematology, nephrology, general medicine, pathology, anesthesiology, radiology, neurology, cardiac catheterization, and social services.

1. Diagnosis and treatment are so closely linked that facilities for both should be included in the same center, to permit the closest possible liaison between professional and support personnel. Cardiac catheterization and open heart surgery both require careful planning, to facilitate close inter-

disciplinary coordination, to minimize unnecessary diagnostic studies, and to allow prompt intervention when life-threatening complications develop during diagnostic procedures.

2. Because open heart surgery is, at times, performed in emergency situations, all facilities providing open heart surgery services should have the capability of rapid mobilization of the surgical and support team for emergency procedures 24 hours a day, 7 days a week. However, most open heart surgery is elective, used by a small proportion of the total population. It is, therefore, neither feasible nor necessary to provide open heart surgical services in close proximity to every patient's community, as this could lead to low volume programs.

3. An adult open heart surgery facility should serve a population of 1,200,000 and a pediatric unit should service a population of 2,000,000.

4. Although research has correlated high volume and better quality for open heart surgery, the correlation is decreasing with time. Volume is only a measure of quality to the extent that it helps maintain physician and hospital team skills, and to the extent that it results from quality services which generate referrals. The maintenance of necessary skills of the surgical team reduces the danger to the patient.

5. An important issue related to the quality of care in open heart surgery is the relationship between surgical volume and mortality. In hospitals, mortality rates for open heart surgery should be no higher than 30/ 1000 procedures.

1. A minimum of 200 open heart procedures should be performed annually, within three years after initiation, in any institution in which open heart surgery is performed for adults.

2. A minimum of 100 pediatric heart operations should be performed annually, within three years after initiation, in any institution in which pediatric open heart surgery is performed, of which at least 75 should be open heart surgery.

3. No institution should have a surgeon and/or surgical team that performs fewer than 100 open heart procedures over a two year period.

4. Open heart surgical services should be available to the population in need of such services within 80 road miles one way.