Open heart surgery in Nigeria; a work in progress

Abstract

BackgroundThere has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme.MethodsThis is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome.Results51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model.ConclusionsThe Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar challenges will need to be overcome by other cardiac stakeholders if other OHS programs are to be developed and sustained in Nigeria.

The burden of Fallot’s tetralogy among Nigerian children

“…Both palliative and definitive surgical correction was required by all the subjects but this is not always available in Nigeria. Cardiac surgery for congenital heart diseases in Nigeria before now has not been available on a regular basis, it was only available when mission group visits, the visit last for only few days with only few cases done, there also exists challenges of availability of diagnostic facilities such as cardiac catheterization until recently, lack of availability of support staff and other lifesaving consumables and blood products made performing surgery on children with TOF almost impossible hence the patients were referred outside Nigeria for surgery (21). The patients who had surgical correction outside Nigeria were referred back to the unit after the correction and they were followed up in the unit.…”

The cost of open heart surgery in Nigeria

“…Efforts to resuscitate OHS in Nigeria are ongoing. 18 cases have been reported from Northern Nigeria [12] and more recently our group at the Lagos State University Teaching Hospital has reported 51 cases of OHS done between 2004 and 2011[13]. A number of other teaching hospitals are at various stages of preparation for starting OHS programs.…”

Congenital heart disease in school children in Lagos, Nigeria: Prevalence and the diagnostic gap

“…However, heart surgery and other definitive management strategies/interventions are too few and far between with most sub‐Saharan countries only able to boast of one or two centers which perform “walk‐in” cardiac surgery and interventions. Nevertheless, a good proportion of sub‐Saharan African countries are the beneficiaries of programs which involve visiting teams performing uncomplicated surgeries on patients and providing skills transfer to the local medical personnel (Falase et al, ). A number of such models have led to the establishment of fully indigenous cardiac care programs over time (Coulibaly et al, ; Edwin, Tettey, Aniteye, et al, ).…”

“…The provision of cardiac centers and training of medical personnel in the management of childhood heart diseases increase the likelihood (Falase et al, 2013). A number of such models have led to the establishment of fully indigenous cardiac care programs over time (Coulibaly et al, 1987;Edwin, Tettey, Aniteye, et al, 2011).…”