Cardiac surgery in low-income settings: 10 years of experience from two countries

Background Access to cardiac surgery is limited in low-income settings, and data on patient outcomes are scarce. Aims To assess characteristics, surgical procedures and outcomes in patients undergoing open-heart surgery in low-income settings. Methods This was a cohort study (2001–2011) in two low-income countries, Cambodia and Mozambique, where cardiac surgery had been promoted by visiting non-governmental organizations. Results In Cambodia and Mozambique, respectively, 1332 and 767 consecutive patients were included; 547 (41.16%) and 385 (50.20%) were men; median age at first surgery was 11 years (interquartile range [IQR] 4–14) and 11 years (IQR 3–18); rheumatic heart disease affected 490 (36.79%) and 268 (34.94%) patients; congenital heart disease (CHD) affected 834 (62.61%) and 390 (50.85%) patients, with increasingly more CHD patients over time (P < 0.001); and the number of patients lost to follow-up reached 741 (55.63%) and 112 (14.6%) at 30 days. A total of 249 (32.46%) patients were lost to follow-up in Mozambique, remoteness being the only influencing factor (P < 0.001). Among patients with known vital status, the early (< 30 days) postoperative mortality rate was 6.10% (n = 40) in Mozambique and 3.05% (n = 18) in Cambodia. Overall, 109 (8.18%) patients in Cambodia and 94 (12.26%) patients in Mozambique underwent re-do surgery. In Mozambique, a further 50/518 (9.65%) patients died at a median of 23 months (IQR 7–43); in Cambodia, a further 34/591 (5.75%) patients died at a median of 11.5 months (IQR 6–54.5). Conclusions Cardiac surgery is feasible in low-income countries with acceptable in-hospital mortality and proof of capacity building. Patient outcomes after cardiac surgery in low-income countries remain unknown, given the strikingly high numbers of lost to follow-up.