Global Unmet Needs in Cardiac Surgery

Zilla, Peter; Yacoub, Magdi H.; Zühlke, Liesl; Beyersdorf, Friedhelm; Sliwa, Karen; Хубулава, Г. Г.; Bouzid, Abdelmalek; Mocumbi, Ana Olga; Devagourou, Velayoudam; Shetty, Devi Prasad; Ofoegbu, Chima; Geldenhuys, Agneta; Brink, Johan; Scherman, Jacques; Toit, Henning du; Hosseini, Saeid; Zhang, Hao; Luo, Xin; Wang, Wei; Mejía, Juan Alberto Cosquillo; Kofidis, Theo; Higgins, Robert S.D.; Pomar, José L.; Bolman, R. Morton; Mayosi, Bongani M.; Madansein, Rajhmun; Bavaria, Joseph E.; Yanes-Quintana, Alberto A.; Kumar, Amit; Adeoye, Oladapo; Chauke, Risenga Frank; Williams, David

doi:10.1016/j.gheart.2018.08.002

Cited by 143 publications

(120 citation statements)

References 31 publications

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“…As called for in the Cape Town Declaration, the main mission of CSIA is to facilitate the establishment of local cardiac surgical capacity rather than fly-in "missions" or sporadic "fly-out" assistance affecting only a few children. As stated in our joint assessment of "Global unmet needs in cardiac surgery" (3) Oceania, RHD outweighs other indications including congenital heart defects by 3-4:1. (2,4) To rather conclude that "Expensive valve replacement surgery in Africa is a disaster and should not be advocated" is out of…”

Section: Response To Letter On the Cape Town Declarationmentioning

confidence: 91%

Response to letter on the Cape Town Declaration

Zilla

Bolman

Boateng

2019

SAHJ

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Volume 16 Number 4 sync with time and does not recognise that all successful models are built on the establishment of local adult cardiac surgical capacity first-onto which the paediatric expertise can build. In an era where even time-pressured private facilities in middle-and high-income countries have eventually come on board with valve repairs (two thirds of mitral valves in Europe and America were repaired in 2017/18) (5,6) and pioneers like Carpentier in Saigon (7) (signatory to the Cape Town Declaration), Sampath Kumnar at the All India Institute in Delhi (8) (signatory to the Cape Town Declaration), and Taweesak Chotivatanapong (9) (signatory to the Cape Town Declaration), have taught those trained in valve replacement how to repair a rheumatic mitral valve with excellent results, and Magdi Yacoub (10) (signatory to the Cape Town Declaration) has successfully pioneered aortic valve repair for rheumatic patients in Aswan-it is unsettling to hear from seasoned surgeons that valve surgery for 4 times more patients than those with CHD, (2,4) who are almost exclusively in their early 20s, is a futile undertaking. We acknowledge the good intention of the authors of the letter, but fear that they were misled in not seeing the bigger picture. We also see this continually resurfacing identical letter as an opportunity to give our learned colleagues an occasional update on the activities of CSIA, (11,12) the wonderful worldwide umbrella the Cape Town Declaration initiated, also in the future.

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Section: Response To Letter On the Cape Town Declarationmentioning

confidence: 91%

Response to letter on the Cape Town Declaration

Zilla

Bolman

Boateng

2019

SAHJ

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“…Of the estimated 1.3 million children born with CHD annually, over 90% do not have access to cardiac care. The poorest countries of the world are marked by the lowest access to cardiovascular surgery (Hoffman, ; Zilla, Yacoub, et al, ). There is one pediatric cardiac surgeon per 3.5 million people in the United States and 1 per 38 million in Africa (often doing both congenital and valve surgery in Africa).…”

Section: Access To Interventionmentioning

confidence: 99%

“…While need for surgery for congenital heart disease (gray) is largely constant throughout the world, rheumatic heart disease (blue) gets gradually replaced by degenerative heart disease (green) as a country moves from low‐to high‐income status. (b) shows the number of cardiac surgeons per 1 million population (Zilla, Yacoub, et al, ). Reproduced with permission…”

Section: Access To Interventionmentioning

confidence: 99%

Congenital heart disease in low‐and‐middle‐income countries: Focus on sub‐Saharan Africa

Zimmerman

Sable

2020

American J of Med Genetics Pt C

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The etiology of congenital heart disease (CHD) is multifactorial. The birth prevalence of CHD is shaped by a wide variety of maternal, fetal, and neonatal risk factors, along with the rates of prenatal diagnosis and terminations of pregnancy, all of which have geographic variability Epidemiology data availability from low‐and‐middle‐income countries (LMIC) on CHD prevalence, morbidity, and mortality are far more limited than from high income countries. Data on specific genetic, environmental, and prenatal risk associated with CHD are almost nonexistent. In this article, we will focus on defining what data are available, genetic risk factors, birth and overall prevalence, morbidity, and the impact of limited access to interventions, both surgery and cardiac catheterizations. We will highlight CHD in sub‐Saharan Africa to detail epidemiology studies in the poorest regions of the world. Existing literature as well as estimates from the Global Burden of Disease Study (http://ghdx.healthdata.org) form the basis for this review. The intersection of poverty, high fertility rates, and limited access to care results in a unique profile of CHD in LMIC. CHD is not a preventable disease (by most standards), so early detection and access are our key interventions to improve the dire outcomes for children in low‐resources settings of the world.

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“…Sub-Saharan Africa (SSA) is faced with enormous demographic and economic challenges. The incidence of cardiac disease in children approximates that of human immunodeficiency virus infection, (4) but especially non-communicable disease is simply not a government priority. Thus, sadly, only 2% of paediatric patients in SSA have access to surgical treatment.…”

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confidence: 99%