Cardiac Surgery and Small Island States: A Bridge Too Far?

Vervoort, Dominique; Vinck, Eric E.; Tiwari, Kaushal K.; Tapaua, Noah

doi:10.1016/j.athoracsur.2020.05.150

Cited by 12 publications

(13 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Brazil, almost 40,000 patients develop chronic RHD each year, a burden that is growing each year and considered to be vastly underestimated 4,5 . Similar trends are observed in the Caribbean, where the annual RHD burden grows and affects a young population, yet surgical and interventional care availability cannot meet the needs of local populations 6 . In Pacific Island States, up to eight percent of the adult population is estimated to have RHD 6 .…”

Section: Introductionmentioning

confidence: 88%

“…6 In Pacific Island States, up to eight percent of the adult population is estimated to have RHD. 6 In sub-Saharan Africa, the epidemiology and demographics of ARF and RHD remain major challenges with a prevalence of 5.7 per 1,000 children aged 5-14 years, whereas endemic regions have adolescent rates up to 21.0 per 1000 people at 16 years. [7][8][9] Although ARF and RHD are driven by a combination of immune, environmental, and genetic factors, high heritability has been shown.…”

Section: Timeline Of Arf and Rhd Developmentsmentioning

confidence: 99%

See 1 more Smart Citation

Rheumatic heart disease: The role of global cardiac surgery

Vervoort

Antunes

Pezzella³

2021

Journal of Cardiac Surgery

Self Cite

View full text Add to dashboard Cite

Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high‐income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low‐ and middle‐income countries (LMICs) and among indigenous and disenfranchised populations in high‐income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub‐Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.

show abstract

Section: Introductionmentioning

confidence: 88%

Section: Timeline Of Arf and Rhd Developmentsmentioning

confidence: 99%

Rheumatic heart disease: The role of global cardiac surgery

Vervoort

Antunes

Pezzella³

2021

Journal of Cardiac Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Five out of 58 small, developing island states, have only local health centers, which are dependent on and served by visiting surgeons. Aruba has no local cardiac surgery center, necessitating the state to send its cardiac patients abroad, costing it 12% of its total healthcare expenditure (23).…”

Section: International State Of Chsmentioning

confidence: 99%

The road to regionalization in congenital heart surgery: a narrative review

Ghandour¹,

Welke²,

Karamlou³

2022

AME Surg J

View full text Add to dashboard Cite

Objective: This review article will highlight the current state of pediatric cardiac surgical care delivery in the United States (U.S.), examine the data that supports regionalization along with the potential drawbacks of such a system, specifically with regard to how these efforts might impact socioeconomic status (SES) and racial/ethnic disparities. We will also discuss global implications for regionalization, and whether emerging healthcare delivery systems should be based on this concept.Background: Concentrating pediatric cardiac surgical care to regional high-volume specialty centers would likely improve patient survival and promote more efficient use of resources. Recent initiatives in two states have proposed minimum volume requirements for pediatric cardiac surgery programs. However, implemented poorly, such a change could exacerbate accessibility issues and would face obstacles in the U.S., including regulatory constraints, antitrust actions and balancing of financial incentives. Real-world studies, as well as theoretical models, indicate that patients undergoing pediatric cardiac surgery at high-quality centers with larger volumes fare better. Other paradigms for care delivery exist across the U.S., including healthcare satellite systems and tiered systems. These alternative models that consist of a large hospital that participates in specialty care for neighboring associated small hospitals or designate certain centers (usually higher tiered centers) to provide a cache of services. Both models require financial alignment, geographic proximity among the participants (usually), and extensive care coordination that defines thresholds for referral of care to the larger hospital.Methods: A comprehensive narrative review on congenital heart surgery (CHS), regionalization, and healthcare policy efforts was carried out. PubMed was used to search articles published on the topic in the past 20 years. The search yielded 944 studies, of which 38 satisfied the inclusion criteria for narrative review.Conclusions: There are no easy answers to the complex questions of whether and how pediatric cardiac surgery should be regionalized to specialty centers in the U.S. or on an international level. Nevertheless, although evidence supports centralization to save lives and lower costs, implementation is challenged by financial and social reasons. Existing centralized services, as exist for organ transplantation and transcatheter valve replacement, demonstrate that regionalization makes sense for complex interventions.

show abstract

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Destination left ventricular assist device placement is increasing as a result of donor shortages and changing patient attitudes. As organ shortages become critical, LVAD programs become fundamental even in more remote regions of the world including island states. Here, we provide a look into the current state and availability of LVAD programs in island states. Main body A narrative review was performed using the World Health Organization Global Index Medicus and PubMed/MEDLINE databases to identify articles describing the island states having reported LVAD placements and programs. Additionally, INTERMACS reports were used. Data were retrieved and a review is presented describing the current state of LVADs in island states. The Caribbean region as a whole has a heart failure (HF) prevalence of 814 per 100,000 and Oceania 667 per 100,000 people. We estimate that over 3000 people in these islands need either a heart transplant or an LVAD. Short conclusion For HF patients living in island regions, special attention should be paid to the inability of having access to specialized mainland medical care. The continuous quest for a solution to HF in island regions should include the establishing of high-quality LVAD programs in a transfer-network centralized/regionalized system to care for those patients not candidates for long-distance air-bridging.

show abstract

Cardiac Surgery and Small Island States: A Bridge Too Far?

Cited by 12 publications

References 13 publications

Rheumatic heart disease: The role of global cardiac surgery

Rheumatic heart disease: The role of global cardiac surgery

The road to regionalization in congenital heart surgery: a narrative review

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

Contact Info

Product

Resources

About