Countries building sustainable, cardiac surgical care must ensure that the local health system has the capacity to support routine postoperative follow-up and generate the infrastructure required to provide timely diagnosis and management of common postoperative complications. Following valvular cardiac surgery, most patients will need management of residual symptoms of heart failure, adjustment and monitor of anticoagulation, administration of lifelong penicillin prophylaxis and guidance on how to navigate family planning. Anticoagulation has historically been seen as an insurmountable challenge in the rural poor; however, in this chapter, we present the PEN-Plus model for decentralized postoperative managementand provide insight into how its application can guide the way forward to support sustain-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.