Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex

Abstract

Background: Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). Objectives: We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country. Methods: Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed. Results: A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2 % Conclusion: Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.

Pediatric cardiovascular care in Uganda

“…[13] Unfortunately, the current volume of CHD surgery at the UHI results in some charities prioritizing taking children abroad for surgery. This has not only caused the flight of foreign currency but also retarded the development of sustainable in-country care programs.…”

The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of Cardiac Surgery: A Meta-Analysis

“…In recent years there have been several studies comparing anesthetics used in cardiac surgery because the latter represents a remarkably cause of morbidity and mortality worldwide, especially in developing countries [ 19 , 28 , 29 ]. Importantly, in cardiac anesthesia volatile anesthetics it is still one of the most important pharmacologic resources for anesthesia maintenance; it is because this type of anesthesia has a better profile (cardioprotective and neuroprotective) than nonvolatile anesthesia.…”

Humanitarian Outreach in Cardiothoracic Surgery: From Setup to Sustainability

“…However, the effective execution of this strategy relies heavily on in-country collaboration and ministerial or governmental commitment. Such partnerships must include opportunities for strengthening multiple components of in-country delivery of care (ie, sponsorship of international or domestic training of in-country staff/ personnel, procurement of capital equipment, and introduction of practice guidelines) [17]. Ideally, this process should focus from the outset on steps toward developing a specialized cardiothoracic treatment center, eventually staffed and operated by the local population.…”

“…In resource-limited settings, timely diagnosis and treatment for many potentially curable diseases is unavailable because of absence or scarcity of skilled human resources, appropriate facilities, and equipment, and the many other disadvantages that plague such areas of the world [17].…”