Cardiac surgery in the Pacific Islands

Area of Science:

• Cardiovascular Surgery
• Global Health
• Public Health

Background:

• Rheumatic heart disease (RHD) poses a significant health burden in underserved regions.
• Volunteer cardiac surgical teams provide essential services to areas with limited resources.
• This study evaluates the outcomes of volunteer cardiac surgery in Samoa and Fiji.

Purpose of the Study:

• To compare the operative results of New Zealand volunteer cardiac surgical teams in Samoa and Fiji.
• To assess surgical mortality and morbidity against accepted Australasian rates.
• To identify challenges in risk prediction for RHD patients in Pacific Island nations.

Main Methods:

• Retrospective review of seven volunteer cardiac surgical trips (2003-2009).
• Data collection included pre-operative risk assessment using the European System for Cardiac Operative Risk Evaluation (euroSCORE).
• Audit data were compiled following Australasian Society of Cardiac and Thoracic Surgeons guidelines.

Main Results:

• 103 operations were performed over six years.
• Predicted operative mortality by euroSCORE was 3.32%.
• Actual 30-day mortality was 3.88% (0.97% in-hospital, 2.91% post-discharge).

Conclusions:

• Cardiac surgery in Fiji and Samoa is feasible and safe, despite slightly higher mortality than predicted.
• Existing risk scoring models are not fully inclusive of disease, ethnic, or cultural factors for Pacific Island RHD patients.
• Improved audit processes and risk model development are crucial for better patient selection and outcomes in charitable cardiac surgery.