Building cardiac surgical programs in lower-middle income countries

Area of Science:

• Global Health
• Cardiovascular Surgery
• Medical Education

Background:

• Low-income countries face significant challenges in delivering adequate medical care due to resource limitations.
• Cardiac surgery programs are often scarce in these regions, leading to unmet patient needs.

Purpose of the Study:

• To evaluate the effectiveness of developing an independent, internationally supported cardiac surgical training program in Kenya.
• To assess clinical outcomes and programmatic growth over time.

Main Methods:

• A retrospective review of programmatic structure and clinical outcomes at Tenwek Hospital, Kenya (2008-2021).
• Analysis of three program development phases: initial surgeon support, volunteer teams, and residency program establishment.
• Evaluation of patient demographics and perioperative outcomes.

Main Results:

• 817 cardiac procedures were performed, with a predominance of adult cases (71.1%) and rheumatic valvular heart disease (62.3%).
• Local surgical teams' case volume surpassed visiting teams by 2019.
• Perioperative mortality was 2.1%, consistent across visiting and local teams. A cardiothoracic residency program is established with graduates retained as staff.

Conclusions:

• International partnerships can effectively address cardiac care deficits in low- and middle-income countries.
• The Kenyan program demonstrated successful transition towards independent cardiac surgical care with acceptable clinical outcomes and growing volume.