Cardiothoracic Surgery in the Caribbean

Abstract

Introduction Despite being one of the main vacation destinations in the world, health care in the Caribbean faces many difficulties. The challenges involved in these islands’ medical care range from low-resource institutions to lack of specialized care. In the field of thoracic and cardiac surgery, many limitations exist, and these include the lack of access to cardiac surgery for many small islands and little governmental funding for minimally invasive approaches in thoracic surgery. Methods Literature review was done using PubMed/MEDLINE and Google Scholar databases to identify articles describing the characteristics of thoracic and cardiac surgery departments on Caribbean islands. Articles on the history, current states of practice, and advances in cardiothoracic surgery in the Caribbean were reviewed. Results Regardless of the middle to high-income profile of the Caribbean, there are significant differences in the speed of technological growth in cardiothoracic surgery from island to island, as well as disparities between the quality of care and resources. Many islands struggle to advance the field of cardiothoracic surgery both through lack of local cardiac surgery centers and limited financial funding for minimally invasive thoracic surgery. Conclusions Cardiac and thoracic surgery in the Caribbean depend not only on the support from local government policies and proper distribution of healthcare budgets, but efforts by the surgeons themselves to change and improve institutional cultures. Although resource availability still remains a challenge, the Caribbean remains an important region that deserves special attention with regard to the unmet needs for long-term sustainability of chest surgery.

Destination left ventricular assist devices in island states: asking too much or the inevitable solution

“…However, only Grand Cayman and Singapore have established LVAD programs. These centers have successfully developed quality cardiovascular care for especially underserved regions of the world [6][7][8]. Despite these endeavors, the burden of HF makes ventricular assistance an underused and necessary solution to many of these islands.…”

“…In island states, there is an increased need for this technology due to the even lower rates of transplantation. The population of island states is approximately 65 million people across 58 islands regions [6,7]. Of these, it is estimated that 540,150 people have or will soon be suffering from HF [2,[6][7][8].…”

“…The population of island states is approximately 65 million people across 58 islands regions [6,7]. Of these, it is estimated that 540,150 people have or will soon be suffering from HF [2,[6][7][8]. Island states and regions such as the Caribbean have an upper-middle-or high-income profile (with the exception of islands such as the Dominican Republic and Haiti).…”

“…Island states and regions such as the Caribbean have an upper-middle-or high-income profile (with the exception of islands such as the Dominican Republic and Haiti). However, population differences and healthcare policy disparities lead to consequences of limited access to quality and immediate cardiac surgical care [6][7][8]. The remote distances of island states from specialized mainland transplant centers make destination LVAD therapy an attractive solution [6][7][8].…”

“…However, population differences and healthcare policy disparities lead to consequences of limited access to quality and immediate cardiac surgical care [6][7][8]. The remote distances of island states from specialized mainland transplant centers make destination LVAD therapy an attractive solution [6][7][8]. In 2019, a record number of 3198 continuous flow LVADs were placed worldwide according to the INTER-MACS database [1].…”