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Surgery for severe congenital heart diseases in children from developing nations
Francois Lacour-Gayet1, Marielle Gouton2, Olivier Bical1
1Mécénat Chirurgie Cardiaque Foundation, Paris, France.
Insights
Surgical outcomes for children with severe congenital heart disease (CHD) from developing countries were successful. The Mécénat Chirurgie Cardiaque program offers a vital option for these children.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Global Health Initiatives
Background:
- Severe congenital heart disease (CHD) significantly limits survival for children in developing countries.
- The Mécénat Chirurgie Cardiaque (MCC) program facilitates surgical treatment for these children by bringing them to France.
- This report evaluates the outcomes of 531 children with severe CHD treated by MCC between 1996 and 2019.
Purpose of the Study:
- To assess the early, mid-term, and long-term outcomes of children with severe CHD undergoing surgery through the MCC program.
- To evaluate the feasibility and effectiveness of international medical missions for treating complex pediatric cardiac conditions.
- To highlight the impact of such programs on survival rates for children from underserved regions.
Main Methods:
- Patient selection based on diagnosis, not surgical procedure.
- Leveraging a network of 700 volunteers, 350 host families, 120 correspondents, and 100 physicians across 66 countries.
- Collaboration with nine French surgical centers and aviation support for patient transport.
- Standardized training for local pediatric cardiologists and robust international follow-up protocols.
Main Results:
- Common diagnoses included single ventricle (n=126) and double-outlet right ventricle (n=116).
- The mean perioperative mortality rate was 5.5% (29/531).
- Actuarial survival rates at 5, 10, and 15 years were 85%, 83%, and 74%, respectively, with 91.3% follow-up achieved.
Conclusions:
- The MCC program successfully provided surgical interventions for 531 children with severe CHD, demonstrating satisfactory early and long-term results.
- Severe CHD treatment is scarce in developing nations, making programs like MCC crucial for improving survival.
- MCC offers a viable and effective solution for managing severe congenital heart disease in children from developing countries.
Background:
Children with severe congenital heart disease (CHD) are rarely treated in developing countries and have very little to no chance to survive in their local environment. Mécénat Chirurgie Cardiaque (MCC) flies to France children with CHD from developing countries. This report focuses on the early, mid, and late outcomes of 531 children with severe CHD sent to MCC for surgery from 1996 to 2019.
Methods:
The inclusion criteria were based on diagnosis and not on procedure. MCC is present in 66 countries and has developed a robust staff, including 12 permanent employees and 700 volunteers, with 350 host families based in France, 120 local correspondents, and 100 local physicians. Since 1996, MCC has organized a basic training of local pediatric cardiologists yearly, offering a free 1-month training course. Over time, MCC could count on a pool of doctors trained in basic pediatric cardiology. Flights were secured by the Aviation Sans Frontieres Foundation. Nine French centers performed the surgeries. A robust follow-up was conducted in all the nations where MCC operates.
Results:
The most frequent pathologies were single ventricle (n = 126), double-outlet right ventricle (n = 116), pulmonary atresia with ventricular septal defect (n = 68), transposition of the great arteries with ventricular septal defect and transposition of the great arteries with intact ventricular septum (n = 61), arterial trunk (n = 39), transposition of the great arteries with ventricular septal defect and left ventricle outflow tract obstruction (n = 35), complete atrioventricular septal defect (n = 18), congenitally corrected transposition of the great arteries (n = 16), and so on. The median age was 5.4 years (range, 1 month-26 years). The mean perioperative mortality was 5.5% (29 out of 531) (95% confidence limit, 3.5%-7.4%). The follow-up was 91.3%, with a mean follow-up of 5.1 years. The global actuarial survival at 5, 10, and 15 years was, respectively, 85%, 83%, and 74%. There was a significant higher late mortality for patients surviving only with a Blalock-Taussig shunt (P = .001).
Conclusions:
Operating on 531 children with severe CHD from developing nations was achieved with satisfactory early and long-term results. Children with severe CHD are rarely operated on in developing nations. Programs like MCC's offer a viable option to save these children born with severe CHD.
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