Commentary: Regionalization = Excellence

Central MessageThe excellent results with surgical repair of AVSD in this review validates the prescient decision to regionalize care children congenital heart disease Sweden from 4 2 centers 1992.See Article page 2145. The 1992. See As I read manuscript submitted by Dr Ramgren and colleagues Lund, Sweden, noted that their infants atrioventricular septal defect (AVSD) began 1993.1Ramgren J.J. Nozohoor S. Zindovic Gustafsson R. Hakacova N. Sjögren J. Long-term outcome after early complete young infants.J Thorac Cardiovasc Surg. 2021; 161: 2145-2153Abstract Full Text PDF PubMed Scopus (18) Google Scholar Given my interest regionalization care, recognized was exactly 1 year centralized dedicated centers.2Lundström N.R. Berggren H. Björkhem G. Jögi P. Sunnegârdh Centralization pediatric surgery Sweden.Pediatr Cardiol. 2000; 21: 353-357Crossref (123) Suddenly became not simply another article on techniques results, but possibly an outcomes analysis strategy embarked upon At time (population 10 million) centers; Lund Göteborg. What effect born treated Sweden? found for patients at center clearly supports hypothesis improves results. were superb! Their nearly 30-year experience more than 300 resulted operative mortality only 1%. freedom left valve-related reoperation remarkable 93% 20 years. Finally, there no difference between (mean age, 1.6 months) versus older 5.1 months). Those are truly some finest have ever seen reported repair! authors themselves point out continuous improvements pre- postoperative management secondary Sweden's centralization facilitated improved clinical outcomes. note 1992 cardiac provided sufficient patient volumes also recruitment highly trained staff all levels support ensure highest possible standards care. There many lessons can be learned detailed strategies experience. even age 6 weeks, staged coarctation aorta, intraoperative focus AV valve. For me, most important message is has true excellence disease. This accomplishment should carefully as we consider various strategies, including regionalization, improve infantsThe Journal Thoracic Cardiovascular SurgeryVol. 161Issue 6PreviewThe long-term still fully understood. objective study evaluate data over a 25-year period assess survival identify risk factors valve–related reoperations. Full-Text Regionalization low- middle-income countries: Principles promiseThe 163Issue 1PreviewWe correspondence Drs Vervoort,1 Backer,2,3 Karamlou4 regarding (CHS) countries (LMICs). discussion Children's Heartlink had second half our 52-year history working different LMICs, majority which underinvested services. globalized worldThe 6PreviewCongenital complex requires services optimize surgeons' skills enables pooling volume surgeons, whilst trying limit geographic barriers result such decisions. Backer1 illustrates pursuit using example shift