IJCS | Volume 31, Nº4, July / August 2018

381 Jesus et al. The wait for surgical treatment of heart disease Int J Cardiovasc Sci. 2018;31(4)374-382 Original Article have shown that there is a linear association between the complexity and cost of the procedure. 19 Another great difficulty that the service faces in reducing the waiting list for elective cardiac surgery is the high demand for urgent surgeries in patients without previous enrollment, as these cases are prioritized to the detriment of elective ones. A strategy to mitigate the problem in the short term would be the performance of congenital heart surgeries in patients already enrolled for it, aiming to reduce the repressed demand of SUS users. 19 In this sense, it is proposed: the creation of outpatient care and specialized centers for the diagnosis and early treatment of the population, reducing underdiagnosing and improving pre- and postoperative clinical follow- up, with a possible reduction of costs for out-of-home treatment and, consequently, less social impact for the affected families; investment in diagnosis performed through computed tomography and cardiac magnetic resonance imaging, which would reduce diagnostic cardiac catheterizations and increase the availability of hospital support for therapeutic procedures; the promotion of hemodynamic procedures, including a fundingpolicy forOrthoses, Devices andSpecialMaterials ( Órteses, Próteses eMateriais Especiais – OPME) not covered by SUS, due to the proven effectiveness and shorter hospital length of stay, with a consequent decrease in hospital expenses and an increase in the volume of treated cases per unit of time; increased functional capacity at the referral hospital; decentralization of surgical and cardiac hemodynamic care, with the internalization of this type of service inmedium-sizedmunicipalities, such as Marabá and Santarém, both in the state of Pará; and reliable, detailed and updated data registry regarding the surgical and hemodynamic procedures, for permanent control and evaluation of the outcomes. The promotion of improvements in the care for children with heart disease is a priority and involves the participation of all – public services, professionals and several sectors of society. Conclusion Most of the children awaiting cardiac procedures come fromoutside themetropolitanareaandhavemalformations potentially treatable through cardiac catheterization. However, evenwith changes in the treatment profile, with the increase in percutaneous procedures in the last years, it still requires further increase. The limitations of the public hospital system inmeeting the great demand of the region for elective therapeutic cardiovascular procedures generate an important care deficit, with the need to increase the functional capacity of the only public referral center for these diseases in the region, as well as decentralization of cardiological, clinical, surgical and hemodynamic care, to better treat the population that depends on SUS. Author contributions Conception and design of the research: Jesus VS, Nascimento AM, Miranda RA, Veríssimo AOL. Acquisition of data: Jesus VS, Nascimento AM, Lima JS. Analysis and interpretation of the data: Jesus VS, Nascimento AM, Veríssimo AOL. Statistical analysis: Jesus VS, Nascimento AM. Writing of the manuscript: Jesus VS, Nascimento AM, Lima JS, Tyll MAG. Critical revision of the manuscript for intellectual content: Miranda RA, Tyll MAG, Veríssimo AOL. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding O presente estudo não teve fontes de financiamento externas. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Fundação Pública Estadual Hospital das Clínicas Gaspar Vianna under the protocol number 39903014.2.0000.0016. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.