title: Cardiac surgery in low-income settings: 10 years of experience from two countries.
abstract: BACKGROUND
  Access to cardiac surgery is limited in low-income settings, and data on patient outcomes are scarce.
  
  
  OBJECTIVE
  To assess characteristics, surgical procedures and outcomes in patients undergoing open-heart surgery in low-income settings.
  
  
  METHODS
  This was a cohort study (2001-2011) in two low-income countries, Cambodia and Mozambique, where cardiac surgery had been promoted by visiting non-governmental organizations.
  
  
  RESULTS
  In Cambodia and Mozambique, respectively, 1332 and 767 consecutive patients were included; 547 (41.16%) and 385 (50.20%) were men; median age at first surgery was 11 years (interquartile range [IQR] 4-14) and 11 years (IQR 3-18); rheumatic heart disease affected 490 (36.79%) and 268 (34.94%) patients; congenital heart disease (CHD) affected 834 (62.61%) and 390 (50.85%) patients, with increasingly more CHD patients over time (P<0.001); and the number of patients lost to follow-up reached 741 (55.63%) and 112 (14.6%) at 30 days. A total of 249 (32.46%) patients were lost to follow-up in Mozambique, remoteness being the only influencing factor (P<0.001). Among patients with known vital status, the early (<30 days) postoperative mortality rate was 6.10% (n=40) in Mozambique and 3.05% (n=18) in Cambodia. Overall, 109 (8.18%) patients in Cambodia and 94 (12.26%) patients in Mozambique underwent re-do surgery. In Mozambique, a further 50/518 (9.65%) patients died at a median of 23months (IQR 7-43); in Cambodia, a further 34/591 (5.75%) patients died at a median of 11.5months (IQR 6-54.5).
  
  
  CONCLUSIONS
  Cardiac surgery is feasible in low-income countries with acceptable in-hospital mortality and proof of capacity building. Patient outcomes after cardiac surgery in low-income countries remain unknown, given the strikingly high numbers of lost to follow-up.
authors.affiliation: Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France; Paris Descartes University, 75005 Paris, France; Cardiology Department, European Georges-Pompidou Hospital, 75015 Paris, France. Electronic address: mariana.mirabel@inserm.fr.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.affiliation: Instituto do Coração (ICOR), 1100 Maputo, Mozambique; Institut du Thorax, 44093 Nantes cedex 1, France.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lachaud
authors.affiliation: Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Offredo
authors.affiliation: Instituto do Coração (ICOR), 1100 Maputo, Mozambique.
authors.forename: Cécile
authors.initials: C
authors.lastname: Lachaud
authors.affiliation: Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zuschmidt
authors.affiliation: Instituto do Coração (ICOR), 1100 Maputo, Mozambique.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ferreira
authors.affiliation: Paris Descartes University, 75005 Paris, France; Instituto do Coração (ICOR), 1100 Maputo, Mozambique; Chaîne de l'Espoir, 75014 Paris, France; Paediatric Cardiology Department, Necker-Enfants-Malades Hospital, 75015 Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sidi
authors.affiliation: Paris Descartes University, 75005 Paris, France; Chaîne de l'Espoir, 75014 Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Chauvaud
authors.affiliation: Centre de Cardiologie de Phnom Penh, Phnom Penh, Cambodia.
authors.forename: Phang
authors.initials: P
authors.lastname: Sok
authors.affiliation: Paris Descartes University, 75005 Paris, France; Chaîne de l'Espoir, 75014 Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Deloche
authors.affiliation: Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France; Paris Descartes University, 75005 Paris, France; Cardiology Department, European Georges-Pompidou Hospital, 75015 Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Inserm U970, Paris Cardiovascular Research Centre, European Georges-Pompidou Hospital, 56, rue Leblanc, 75737 Paris, France; Paris Descartes University, 75005 Paris, France; Cardiology Department, European Georges-Pompidou Hospital, 75015 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
mesh_terms: D000293:Adolescent; D002160:Cambodia / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005544:Forecasting; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D011203:Poverty; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends
keywords: Acute rheumatic fever; Cardiac surgery; Congenital heart disease; Developing countries; Global health; Médecine d’urgence; Rheumatic heart disease; Échographie cardiaque; Échographie cardiaque ciblée; Éducation