Cardiac Surgery and Small Island States: A Bridge Too Far?

Small island developing states (SIDS) make up nearly 1% of the world's population, with 65 million people across 58 countries. Small island developing states have some of the highest rates of rheumatic heart disease in addition to a substantial burden of congenital heart defects and a growing burden of ischemic heart disease. Here, we present an overview of cardiac surgical services in SIDS, with a focus on Papua New Guinea, the Maldives, and Aruba.

We performed a literature review using the PubMed/MEDLINE and Google Scholar databases to identify articles describing cardiac surgery services in SIDS. Case studies of the history and current state of cardiac surgery in Papua New Guinea, the Maldives, and Aruba were developed and informed by local clinical experience.

Nine SIDS have independent cardiac surgical centers and 5 SIDS have local centers supported by visiting teams. Papua New Guinea started cardiac surgery in 1993 and is served by a public center, performing nearly 100 cardiac surgeries per year. The Maldives introduced cardiac surgery services in 2018, with 1 local cardiac surgeon supported by Nepalese cardiac surgeons, performing 33 cardiac surgeries in 15 months. In Aruba, no local cardiac center exists and over 150 patients are sent abroad for cardiac surgery, representing 12% of total health spending.

Small island developing states have limited availability of cardiac surgery but pressing clinical needs. Independent cardiac centers exist with acceptable outcomes and lower costs than foreign treatment, which suggests the need to strengthen regionalization models to deliver cardiac surgical care in SIDS.