Abstract:
Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack
access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth
and challenges with sustainability. Methods: Records of patients undergoing heart surgery at
LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome
data. Results: Twenty four patients age 10 - 50, mean 28.0 +/− 10.49 years and 13 (54.2%)
males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%)
closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve
patients was 5.81 +/− 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative
mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure
stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration
of 55.2 +/− 15.3 months. Late events occurred only in females with mitral valve replacements.
The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0%
in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed
with good outcomes by trained local personnel under supervision of visiting foreign teams until
they are proficient to operate independently. Patients with less complex congenital defects have
excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to
ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of
prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We
now prefer stented tissue valve despite its known limitations, in child bearing age females desirous
of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to
sustainability include poor infrastructures, few skilled manpower, inadequate funding and
restricted patient access due to inability to pay without third party insurance or government
Medicaid.
