ABC | Volume 114, Nº4, April 2020

Original Article Mejia et al. Quality, the new era of cardiovascular surgery Arq Bras Cardiol. 2020; 114(4):603-612 Figure 4 – Year-by-year graph of volume and mortality in Congenital Heart Disease Surgeries in > 35 years of the InCor. Mortality rate observed (%) Number of surgeries 12 15 9 3 6 400 200 600 800 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019-1S Quantidade de Cirurgias Tx de Mortalidade Observada Congenital Table 3 – Annual volume categorized by Procedure type (2008 – 1S/2019) 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 1S 2019 Acute Aortic Dissection 42 36 54 25 19 40 78 77 72 76 72 44 Congenital 466 446 466 530 500 573 638 617 566 617 612 332 CABG 715 660 607 634 665 583 611 622 547 523 554 381 CABG + Valve 76 68 65 68 79 88 89 62 40 67 46 39 Aortic Valve 176 153 138 153 164 211 215 191 198 173 214 109 Aortic and Mitral Valve 68 59 49 66 54 49 51 63 55 58 67 50 Mitral Valve 210 181 125 154 204 212 234 258 235 208 217 199 although in this period there was the implementation of certain improvement initiatives, these were not convergent, and, consequenlty, could not be structured and far less sustainable. The success of centers that had already started to work on the organization and structuring of improvement programs started to show results. In this respect, in 2012, the European Association for Cardio-Thoracic Surgery (EACTS) established its Quality Improvement Programme (QUIP) with the purpose of improving the outcomes, as well as integrating strategies for quality improvement. 16 The Cardiovascular Surgery Division of the InCor started to create improvement initiatives through an organizational culture that focused on reducing mortality outcomes by following established goals. These goals at first followed historical data, which means improving one's own results. This is one of the best ways to create progressive and sustainable results. Because it understood the importance of multicenter registries and of continuous and collaborative learning, the InCor, by means of a partnership with the SES-SP, and the FAPESP, created, in 2013, the Paulista Cardiovascular Surgery Registry. 6 After this initiative, the InCor gained a better understanding of the outcomes and could guide its strategies better. As a result, in 2016, the InCor, with the establishment of a data-driven culture, converged its improvement measures through the implementation of its CQI Program. 9 This analysis was carried out with 105,599 cardiovascular surgeries and it is possible to observe that, since 1984, the 608