Background:The New Brunswick Heart Centre (NBHC) entered a contractual partnership with Integrated Health Solutions (IHS) to help address increasing wait times in the province of New Brunswick.Methods: Team leaders were identified from each of the target areas, including surgeons, anesthesiologists, nurses (operating room, intensive care unit [ICU] and postoperative ward), access coordinators and administrators. The methodology used was based on Lean principles and involved exercises by stakeholders aimed at identifying opportunities for improvement. A weekly dashboard was created to monitor and facili tate improvement efforts. No additional hospital beds or operating room theatres were added during the study period.Results: After 2 years, the annual number of cardiac surgical interventions increased from 788 to 873, representing a 10.8% increase in capacity. The best median wait time for patients decreased from 52 to 35 days (35% reduction). The best 90th percentile wait time decreased from 126 to 98 days (22% reduction). The overall increase in capacity could be explained in part by the significant increase in fast tracking from the ICU to the ward (> 2-fold) or bypassing the ICU altogether (4-fold increase reaching 13%). Despite these successes, challenges persist as the number of OR cancellations remained around 7.5% of all cases, mainly because of limited ICU resources. Conclusion:The NBHC-IHS partnership on this project has resulted in excellent engagement by stakeholders and promoted team cohesiveness. Furthermore, it has allowed significant reorganization and realignment of efforts to limit wait times and maximize overall capacity. Contexte : Le New-Brunswick Heart Centre (NBHC) a conclu une entente contractuelle avec Integrated Health Solutions (IHS) pour remédier aux temps d'attente de plus en plus longs au Nouveau-Brunswick. Méthodes : Des chefs d'équipe ont été identifiés pour chaque domaine cible, notamment la chirurgie, l'anesthésie, les soins infirmiers (en salle d'opération, aux soins intensifs et en soins postopératoires), la coordination des soins et la direction. La méthodologie utilisée se fondait sur l'approche Lean et comprenait des exercices visant à relever les possibilités d'amélioration. Un tableau de bord hebdomadaire a été créé pour suivre et faciliter les mesures d'amélioration. On n'a ajouté aucun lit d'hôpital et aucune salle d'opération pendant la période étudiée.Résultats : Après 2 ans, le nombre de chirurgies cardiaques par année est passé de 788 à 873, une augmentation de 10,8 % de la capacité. Le temps d'attente médian pour les patients est tombé de 52 à 35 jours (réduction de 35 %). Le temps d'attente au 90 e centile est passé de 126 à 98 jours (réduction de 22 %). L'augmentation générale de la capacité peut s'expliquer en partie par la réduction significative du temps passé aux soins intensifs avant l'admission en soins généraux (> 2 fois) ou par l'élimination complète du passage aux soins intensifs (augmentation de 400 %; 13 % des cas). Malgré ces réussites, des défis demeur...

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function/status prior to the procedure and clinical cardiovascular conditions while the CIHI model included more variables pertaining to non-cardiac comorbidities. The primary outcome was in-hospital mortality within 30 days of the operation. Model performance was established by comparing predicted and observed mortality, model calibration and handling of critical covariates. Observed mortality rate was 1.96% (95%CI: 1.40-2.75%) which was similar to STS predicted mortality (1.96%) but significantly higher than CCQI-predicted mortality (1.03%). Despite both models having similar c-statistics (0.756 CCQI; 0.758 STS), the CCQI model showed significant underestimation of probability of mortality at the higher end of the risk spectrum. There was significant miscalibration (underestimation in the CCQI model) of risk, which was largely driven by seven important pre-operative covariates: NYHA class IV; prior congestive heart failure; left ventricular ejection fraction <20%, prior atrial fibrillation; acute coronary insufficiency; cardiac compromise (defined by the presence of shock, myocardial infarction <24 hours, intra-aortic balloon pump in situ, cardiac resuscitation prior to surgery, or pre-procedure circulatory support); and creatinine concentration 100mg/ dL. Together, these factors accounted for 84% of the variation in predicted mortality between the CCQI and STS models. CONCLUSION: Risk prediction using administrative data underestimated mortality risk compared to a validated clinical model. The use of administrative data sources for riskadjusted mortality reporting may inflate observed to predicted mortality ratios at hospitals with patients who are more ill, more complex, or are at the higher end of the clinical risk spectrum. Caution is warranted when hospital outcomes reports of cardiac surgery are based on administrative data alone. MINIMALLY INVASIVE PERIAREOLAR APPROACH TO REPAIR OF COR TRIATRIATUMA Hage, B Gottschalk, S Fujii, A Grant, I Iglesias, M Chu London, OntarioCor Triatriatum Sinister is an uncommon cardiac abnormality characterized by a membrane that divides the left atrium into two chambers. Definitive management requires surgical resection, traditionally through sternotomy. Minimally invasive surgery often offers a more cosmetically appealing approach with quicker recovery times. We present a 29-year-old female with Cor Triatriatum Sinister and associated atrial septal defect who underwent successful minimally invasive repair through a right periareolar approach. In this video session, we review the preoperative imaging, considerations for approach, and surgical technique with intraoperative echocardiography.