Our Summary

This research paper discusses a major global health issue: the lack of access to heart surgery in developing countries. In 2017, top heart surgeons, heart doctors, medical journal editors, representatives from the medical industry, and government officials gathered to discuss this issue. This meeting led to the “Cape Town Declaration,” which called on heart surgery societies to work together to improve access to heart surgery in developing countries. This led to the creation of the Cardiac Surgery Intersociety Alliance (CSIA), which includes major heart surgery societies from around the world.

The first step CSIA took was to identify the biggest heart health issues in low-income countries. They found that rheumatic heart disease, a condition that can damage the heart valves, was the most common issue requiring surgery.

Next, CSIA asked for proposals to support new programs that had the backing of their local governments and healthcare institutions. After reviewing 11 proposals and visiting the top 3, they chose Mozambique and Rwanda as the first places to start these programs.

In Mozambique, a partnership was formed with the University of Cape Town. This partnership involves regular video calls between healthcare teams, training in all aspects of heart surgery, and on-site support from experienced teams for complex cases.

In Rwanda, a non-governmental organization called Team Heart, which has been providing heart surgery and training in Rwanda since 2008, agreed to continue their work and help establish a self-sufficient heart surgery program. This includes regular virtual meetings between Rwandan and US heart doctors to discuss surgical cases.

Five years after CSIA was founded, their endorsement of the programs in Mozambique and Rwanda has led to more surgeries being performed, stronger government support, improved medical facilities, generous donations of medical supplies, and discussions with global donors about major funding. The aim is to extend this work to other deserving programs and continue building local heart surgery capacity in developing countries.

FAQs

  1. What is the Cardiac Surgery Intersociety Alliance (CSIA) and why was it created?
  2. What were the first steps taken by the CSIA to improve access to heart surgery in developing countries?
  3. What are some accomplishments of the CSIA’s programs in Mozambique and Rwanda?

Doctor’s Tip

A helpful tip a doctor might give a patient about cardiac surgery is to follow post-operative care instructions closely, including taking medications as prescribed, attending follow-up appointments, and following a healthy lifestyle with regular exercise and a heart-healthy diet. It is important to communicate any concerns or symptoms to your healthcare team promptly to ensure a successful recovery.

Suitable For

Patients who are typically recommended for cardiac surgery include those with severe heart conditions that cannot be managed with medication or other less invasive treatments. These may include:

  1. Coronary artery disease: Patients with severe blockages in the arteries supplying blood to the heart muscle may need coronary artery bypass surgery or other interventions to restore blood flow.

  2. Valvular heart disease: Patients with damaged or malfunctioning heart valves, such as those affected by rheumatic heart disease, may require valve repair or replacement surgery.

  3. Congenital heart defects: Infants, children, and adults with congenital heart abnormalities may need surgery to correct structural defects and improve heart function.

  4. Heart failure: Patients with advanced heart failure that does not respond to medication or other treatments may be candidates for heart transplant or implantation of a ventricular assist device.

  5. Aortic aneurysm: Patients with an enlarged or weakened section of the aorta may require surgery to repair or replace the affected portion of the blood vessel.

  6. Arrhythmias: Patients with abnormal heart rhythms that cannot be controlled with medications or other interventions may benefit from procedures such as catheter ablation or implantation of a pacemaker or defibrillator.

It is important for patients to undergo a thorough evaluation by a cardiologist and cardiac surgeon to determine the most appropriate treatment plan for their specific condition. Additionally, access to cardiac surgery in developing countries is crucial to address the growing burden of cardiovascular disease and improve outcomes for patients in need of life-saving interventions.

Timeline

Before cardiac surgery:

  • Patient is diagnosed with a heart condition that requires surgery
  • Patient undergoes pre-operative assessments, including blood tests, imaging scans, and consultations with the surgical team
  • Patient is educated about the surgery, risks, and post-operative care
  • Patient may undergo lifestyle and medication changes to prepare for surgery

After cardiac surgery:

  • Patient is taken to the intensive care unit (ICU) for monitoring and initial recovery
  • Patient may be on a ventilator and receive pain medication
  • Patient is gradually weaned off the ventilator and monitored closely for any complications
  • Patient begins physical therapy and rehabilitation to regain strength and mobility
  • Patient is discharged from the hospital and continues follow-up care with the surgical team
  • Patient may need to make lifestyle changes, take medications, and attend cardiac rehabilitation programs to improve heart health and prevent future issues.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cardiac surgery include:

  1. What specific heart condition do I have that requires surgery?
  2. What are the risks and benefits of the proposed cardiac surgery for my condition?
  3. What is the success rate of this type of surgery in treating my condition?
  4. What is the recovery process like after the surgery?
  5. Will I need any additional treatments or medications after the surgery?
  6. How long will I need to stay in the hospital after the surgery?
  7. What lifestyle changes will I need to make post-surgery to ensure a successful recovery?
  8. What are the potential complications of the surgery and how are they managed?
  9. How experienced is the surgical team in performing this type of surgery?
  10. Are there any alternative treatment options to consider before undergoing surgery?

Reference

Authors: Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Journal: J Thorac Cardiovasc Surg. 2024 Oct;168(4):e104-e116. doi: 10.1016/j.jtcvs.2024.04.031. Epub 2024 Jun 10. PMID: 38864805