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Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art Review.

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Millions in low- and middle-income countries (LMICs) lack cardiac surgery access. This review highlights progress, challenges, and the potential for expanding sustainable cardiac surgical care globally, despite prevailing skepticism.

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Area of Science:

  • Global Health
  • Surgical Care
  • Public Health Policy

Background:

  • Six billion individuals in low- and middle-income countries (LMICs) face limited access to essential cardiac surgical care.
  • Cardiac surgery remains a low priority on global public health and surgery agendas.
  • Significant disparities exist in the provision of timely and affordable cardiac surgical services.

Purpose of the Study:

  • To conduct a state-of-the-art review of cardiac surgical care in LMICs.
  • To identify key milestones, current progress, and challenges in expanding sustainable cardiac surgery.
  • To address the global public health agenda for cardiovascular surgical diseases.

Main Methods:

  • Literature review of PubMed/MEDLINE and Google Scholar databases.
  • Utilized keywords: cardiac surgery, global health, and LMIC.
  • Assessed global burden of cardiovascular surgical diseases using the IHME Global Burden of Disease Results Tool.

Main Results:

  • High-income countries possess over 100 times more cardiac surgeons per capita than low-income countries.
  • LMICs have less than one cardiac center per 10 million population.
  • A disproportionately small number of the global 1.5 million annual cardiac operations occur in LMICs, despite favorable cost-effectiveness.

Conclusions:

  • Skepticism regarding the need, feasibility, and cost-effectiveness of cardiac surgery in LMICs persists.
  • Recent advancements, case studies, and data demonstrate the potential for expanding global cardiac care.
  • Opportunities exist to integrate cardiac surgery into broader health system strengthening initiatives.