Mariana Mirabel1, Matthias Lachaud2, Lucile Offredo3, Cécile Lachaud4, Benjamin Zuschmidt3, Beatriz Ferreira4, Daniel Sidi5, Sylvain Chauvaud6, Phang Sok7, Alain Deloche6, Eloi Marijon8, Xavier Jouven8. 1. Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France; Paris Descartes University, 75005 Paris, France; Cardiology Department, European Georges-Pompidou Hospital, 75015 Paris, France. Electronic address: mariana.mirabel@inserm.fr. 2. Instituto do Coração (ICOR), 1100 Maputo, Mozambique; Institut du Thorax, 44093 Nantes cedex 1, France. 3. Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France. 4. Instituto do Coração (ICOR), 1100 Maputo, Mozambique. 5. Paris Descartes University, 75005 Paris, France; Instituto do Coração (ICOR), 1100 Maputo, Mozambique; Chaîne de l'Espoir, 75014 Paris, France; Paediatric Cardiology Department, Necker-Enfants-Malades Hospital, 75015 Paris, France. 6. Paris Descartes University, 75005 Paris, France; Chaîne de l'Espoir, 75014 Paris, France. 7. Centre de Cardiologie de Phnom Penh, Phnom Penh, Cambodia. 8. Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France; Paris Descartes University, 75005 Paris, France; Cardiology Department, European Georges-Pompidou Hospital, 75015 Paris, France.
Abstract
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 23months (IQR 7-43); in Cambodia, a further 34/591 (5.75%) patients died at a median of 11.5months (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.
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 23months (IQR 7-43); in Cambodia, a further 34/591 (5.75%) patients died at a median of 11.5months (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.
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