Development of a High-Performing Congenital Heart Program in Vietnam

Area of Science:

• Pediatric Cardiac Surgery
• Global Health Equity
• Quality Improvement in Healthcare

Background:

• Children's HeartLink and UCSF partnered with Vietnam National Children's Hospital (VNCH) in 2017.
• VNCH is a high-performing center among low- and middle-income countries (LMICs) in congenital heart disease care.
• This study compares VNCH outcomes to North American centers using Pediatric Cardiac Critical Care Consortium (PC4) data.

Purpose of the Study:

• To compare the surgical outcomes of VNCH with North American centers in 2023.
• To evaluate the impact of a long-term partnership on congenital heart surgery outcomes in an LMIC setting.
• To identify specific areas for continued improvement at VNCH.

Main Methods:

• Leveraged data from the Pediatric Cardiac Critical Care Consortium (PC4) for North American centers and VNCH data for 2023.
• Utilized a partnership model involving semiannual training visits and weekly case conferences from UCSF volunteers.
• Converted Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores to STAT scores for outcome comparison.

Main Results:

• VNCH performed 1,056 operations, compared to 14,506 in PC4 centers.
• VNCH demonstrated comparable overall outcomes but had higher surgical mortality for infants with prematurity and noncardiac abnormalities, and a higher rate of surgical site infections.
• VNCH performed fewer operations on patients with noncardiac abnormalities and higher STAT scores.

Conclusions:

• Partnerships between well-resourced and under-resourced centers can significantly improve congenital heart surgery outcomes.
• VNCH is a high-volume center with respectable outcomes, demonstrating the success of the collaborative model.
• Future efforts should focus on increasing STAT level and neonatal surgeries at VNCH.