Bijzondere interventies aan het hart - Gezondheidsraad

stenosis. The use of stents has been a major development in this regard. This is
due to the benefits of this technique in terms of reducing the risk of a recurrence
of the stenosis (re-stenosis).
The growth in percutaneous coronary interventions has been accompanied by
an increased requirement for a more effective dialogue and closer cooperation
between interventional cardiologists and heart surgeons. This is a prerequisite for
the integrated treatment of patients with complex disorders and a high level of
risk. Accordingly, every effort should be made to achieve this goal. Despite the
ever increasing opportunities for using PCIs, surgical interventions (CABG) can
still provide better long-term treatment results for some patients (survival benefit,
reduced risk of repeat interventions). It is essential that there be effective consultation
in this regard, also involving the patient.
Here too, maintaining the requirements concerning the minimum number of
procedures and the availability of interventional cardiologists remains essential.
Clear criteria have been formulated for assessing the quality of PCI centres. The
Health Council endorses the minimum figure of 600 procedures per annum, and
the requirement that at least four interventional cardiologists should be available.
In addition, the anticipated increase to 40,000 PCIs means that capacity in the
Netherlands needs to be expanded. An increase of this kind can best be carried
out in stages. This means that, during the first phase (up to 2009), the remaining
capacity of current centres (about 11,500 procedures) will be fully utilised. During
this period, no new centres will be established. In the second phase (post
2009), the situation will need to be reassessed, to determine whether there is a
requirement to expand capacity still further. If that does indeed prove to be the
case, then a decision can be taken to establish new centres.
The latter option will have to be prepared and implemented at regional level.
This will facilitate close collaboration at the level of primary health care (GPs
and ambulance services) and secondary health care (PCI centres and cardiac centres
with on-site heart surgery facilities).
If this process is to operate efficiently, then it is advisable that the current permit
policy be continued. In that context, an advisory committee including government
representatives and the professionals involved could be set up to assess
the initiatives of candidate centres in the light of the regional vision.
The treatment of cardiac arrhythmias
Patients with cardiac arrhythmias now have a wide range of treatment options.
These include antiarrhythmic surgery (maze procedure), invasive cardiology and
electrophysiological therapy (catheter ablation, ICD implantation, and the use of
36 Bijzondere interventies aan het hart