title: Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda.
abstract: OBJECTIVE
  Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD.
  
  
  OBJECTIVE
  We describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda's current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD.
  
  
  METHODS
  Interviews with key personnel and review of administrative records were conducted to obtain qualitative and quantitative data on the recruitment of clinical personnel, procurement of equipment, and program finances. The number of surgical cases completed and the resultant clinical outcomes are reviewed.
  
  
  RESULTS
  From 2008 to 2013, six annual visits were completed. A total of 128 prosthetic valves have been implanted in 86 complex patients in New York Heart Association (NYHA) class III or IV heart failure, with excellent clinical outcomes (5 % 30-day mortality). Postoperative complications included a cerebrovascular accident (n = 1) and hemorrhage, requiring reoperation (n = 2). All procedures were performed with participation of local personnel.
  
  
  CONCLUSIONS
  This strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA, jdswain@partners.org.
authors.forename: JaBaris D
authors.initials: JD
authors.lastname: Swain
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Pugliese
authors.forename: Joseph
authors.initials: J
authors.lastname: Mucumbitsi
authors.forename: Emmanuel K
authors.initials: EK
authors.lastname: Rusingiza
authors.forename: Nathan
authors.initials: N
authors.lastname: Ruhamya
authors.forename: Abel
authors.initials: A
authors.lastname: Kagame
authors.forename: Gapira
authors.initials: G
authors.lastname: Ganza
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Come
authors.forename: Suellen
authors.initials: S
authors.lastname: Breakey
authors.forename: Bonnie
authors.initials: B
authors.lastname: Greenwood
authors.forename: Jochen D
authors.initials: JD
authors.lastname: Muehlschlegel
authors.forename: Cecilia
authors.initials: C
authors.lastname: Patton-Bolman
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
authors.forename: R
authors.initials: R
authors.lastname: Morton Bolman
mesh_terms: D000293:Adolescent; D000328:Adult; D057191:Capacity Building / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005260:Female; D005582:Foundations; D006077:Government Agencies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000193:education; D006801:Humans; D008297:Male; D008611:Mentors; D008875:Middle Aged; D018579:Patient Selection; D015397:Program Evaluation / Q000191:economics; D055818:Public-Private Sector Partnerships / Q000191:economics / Q000458:organization & administration*; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D012432:Rwanda; D013523:Surgical Equipment / Q000600:supply & distribution; D016896:Treatment Outcome; D000078329:Workforce; D055815:Young Adult
references.citation: Asian Cardiovasc Thorac Ann. 2006 Aug;14(4):355-6
references.pmid: 16868118
references.citation: Tex Heart Inst J. 2008;35(3):301-6
references.pmid: 18941604
references.citation: Circulation. 2012 Jun 26;125(25):3060-2
references.pmid: 22626744
references.citation: Clin Epidemiol. 2011 Feb 22;3:67-84
references.pmid: 21386976
references.citation: Indian J Med Res. 2013 Apr;137(4):643-58
references.pmid: 23703332
references.citation: Circulation. 2009 Aug 25;120(8):709-13
references.pmid: 19667233
references.citation: Prev Med. 2002 Sep;35(3):250-7
references.pmid: 12202067
references.citation: Pan Afr Med J. 2013;14:61
references.pmid: 23565308
references.citation: N Engl J Med. 2007 Aug 2;357(5):439-41
references.pmid: 17671252
references.citation: Curr Probl Cardiol. 2010 Feb;35(2):72-115
references.pmid: 20109979
references.citation: Heart Lung Circ. 2010 May-Jun;19(5-6):273-81
references.pmid: 20356783
references.citation: Biomaterials. 2007 Jun;28(18):2861-8
references.pmid: 17353047
references.citation: Lancet Infect Dis. 2005 Nov;5(11):685-94
references.pmid: 16253886
references.citation: N Engl J Med. 2007 Aug 2;357(5):470-6
references.pmid: 17671255
references.citation: Expert Rev Cardiovasc Ther. 2009 Dec;7(12):1621-9
references.pmid: 19954323
references.citation: Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):343-51
references.pmid: 23652737
references.citation: Cardiovasc J Afr. 2012 Apr;23(3):165-7
references.pmid: 22555641
references.citation: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008;:3-6
references.pmid: 18396218
references.citation: Arch Pediatr Adolesc Med. 1999 Jul;153(7):681-8
references.pmid: 10401800
references.citation: Lancet. 2008 Jul 19;372(9634):256-61
references.pmid: 18619670
references.citation: World J Pediatr Congenit Heart Surg. 2012 Apr 1;3(2):241-3
references.pmid: 23804781