The congenital database and the Streif in Kitzbuhel

Abstract

The Streif in Kitzbuhel, Austria, is regarded as the most challenging ski downhill race. It starts with the ‘Mausefalle’ (the mousetrap), a stunning, almost vertical jump—the most dangerous in the whole championship circuit—that propels skiers within seconds to a rocket speed and a landing compression of over 1000 kg (Fig. 1). Every champion will tell you that you may have already lost the race with a timorous jump, but you still have not won it with an intrepid and successful one. Only about 150 of the 3312 m would have been accomplished, and the rest of the steep slope is a succession of fall away turns and leaps, many with limited visibility and on glaring ice. This month, the Journal publishes two reports from the two largest congenital databases—the European and the The Society of Thoracic Surgeons (STS) National ones [1, 2]—and gives the opportunity to recall the main objectives and limitations of these registries. In one report, the various methods to enlarge the right ventricular outflow tract (RVOT) in Tetralogy of Fallot are evaluated, and in the other, an overview of a large spectrum of congenital procedures with its attendant mortality is given. The primary goal of the database is to improve the quality of care and patients’ safety [3]. The congenital database gathers and monitors the procedures performed in the field of congenital heart defects, and reports their early outcome. This analysis and the establishment of an average performance set a reliable reference for individual measurement and should positively impact on the quality of care. The 30-day mortality rate is the cornerstone of the outcome. This rate certainly provides important information regarding an operative risk but, like the Streif initial jump, remains incomplete in the assessment of the overall success or benefit of an operation. In many situations, an increased operative risk is bargained with a better long-term quality of life and survival. Take the arterial switch, the double switch or the Bex-Nikaidoh procedure as examples. None of them would compete favourably in a 30-day mortality with their