House of Representatives faces painful choices regarding closure of children’s heart centers

Yet since then, the criticism of De Jonge’s decision from the medical world has only increased. The big problem is that he has never had a thorough investigation, a so-called impact analysis, carried out into the adverse effects of closing heart centers.

‘Specialized care will disappear from the Netherlands if this decision goes through’

For example, specialists in Leiden state that heart surgery on an unborn child (this is only possible in a few places in Europe, Leiden is one of them, ed.) will no longer be possible in the Netherlands if pediatric heart specialization disappears from Leiden.

This is because all complex care for fetuses in the Netherlands is already concentrated in Leiden. A small part of the procedures for unborn children involves a heart procedure. According to Monique Haak, the fetal surgeon, collaboration with an interventional cardiologist is necessary to make this procedure possible.

“This is a procedure with a high mortality risk,” Haak says. “Acute situations are to be expected and you can only deal with them properly if you are fully attuned to each other. That is why we do other interventions together, such as blood transfusions, to stay attuned to each other. If my cardiologist leaves, that cooperation will be lost and I will stop heart surgery on a fetus. I think the risk for the patients is too great.”

A similar situation is playing out in Groningen. This is where the specialization in heart-lung transplants is located. “You need a good heart program and accompanying doctors for that,” department head Eduard Verhagen said in the House of Representatives on Monday.

The same can be said for Erasmus MC, the nationally designated expert for heart transplants in children.

De Jonge’s decision has been paused

An impact analysis had made these bottlenecks and others – there are also concerns about the consequences for scientific research – insightful.

The current Minister of Health, Welfare and Sport, Ernst Kuipers, has decided to suspend his predecessor’s decision and to have an impact analysis carried out by the National Healthcare Authority (NZa). If this shows that there are “well-founded substantive reasons for making a different choice about the locations”, Kuipers wants to reconsider the earlier choice.

Impact analysis may be limited

Kuipers does want to bind the NZa’s research to strict requirements. For example, it must be established in advance that two centers will remain and not three. That limits the possibilities for alternative scenarios.

Tomorrow the House of Representatives will debate with the minister, among other things about the scope of the impact analysis. “Carefulness for everything,” said PvdA MP Kuiken on Monday. “I think it is sensible that a step has been taken around the location and the impact. A discussion that is now coming back in full force: are we going to three or two centers?”

Nico Blom, professor of pediatric cardiology and himself a cardiologist at the LUMC, proposes ‘a complete reset’ in which a scenario of three centers is also possible. “Then we have a concentration of one heart center per 5.8 million inhabitants. Then we are just below Great Britain and France, which have the highest concentration with one center per 6 and 6.1 million inhabitants.”

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