Do outcomes justify emergence of new cardiac centres

To assess if quality cardiac surgical results can be delivered in a third world country like Pakistan.

Our report focused on the initial 2-years experience (June 2005-June 2007) at a new institution Tabba Heart Institute, Karachi. Individual mortality rates of adult cardiovascular surgeries done at our institution were compared with the Society for Thoracic Surgery (STS), European Association of Cardiothoracic Surgery (EACTS) databases and one of the more commonly applied models for predicting post-operative mortality, EuroSCORE. All sets of data were not adjusted for risk.

Total of 1017 open heart surgeries were performed. Age range for our series was 15-80 years, 777 were men and 240 females. Of these 891 were isolated CABG, 25AVR, 50 MVR, 27 AVR+MVR, 11 CABG+AVR and 13 CABG+MVR. 12.9% patients had LVEF < 30% and 11.7% had critical left main coronary disease. In all, 15% of our cases were performed on an emergency basis. Observed mortality rates at Tabba Heart Institute (3.94%) were much lower when compared to those documented by STS database (5.45%), EACTS (6.18%) and EuroSCORE (8.7%).

With post-operative mortality an inverse indicator of quality health care, the results were good, despite several geographical, financial and demographical limitations in reproducing results comparable to international standards. This shows a maximum contribution in providing first grade cardiac support in a developing country like Pakistan.