AFRICA Cardiovascular Topics Tabula viva chirurgic: a living surgical document (original) (raw)
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Open-heart surgery and coronary artery bypass grafting in Western Africa
Pan African Medical Journal, 2011
We read with concern the paper of Budzee and colleagues in a recent issue of the Pan African Medical Journal. We wish to draw the attention of the authors and the readership of the journal to gross inaccuracies in the report. The first open-heart surgery in Nigeria is reported to have taken place on 1 st February 1974 at the University of Nigeria Teaching Hospital (UNTH) in Enugu. Publications from the group in Abidjan indicate the performance of the first 300 cases of open-heart surgery by 1983, the figure increasing to 850 by 1987. Senegal reportedly began performing open-heart surgery in 1995 and is currently a reference point for open cardiac procedures for francophone West Africa. The Ghanaian open-heart experience began in 1964 when surface cooling was used to achieve hypothermia for the successful closure of an atrial septal defect. However, it was not until 1989 that Ghana's National Cardiothoracic Center (NCTC) was established. The NCTC performs regular open-cardiac procedures covering almost the entire spectrum of cardiothoracic procedures including video-assisted thoracoscopic surgery (VATS). The NCTC is equipped with modern cardiovascular/thoracic facilities and has been accredited by the West African College of Surgeons as a center of excellence for the training of cardiothoracic surgeons and has performed creditably in this regard. It is emphasized that open-heart surgery has been practiced in West Africa for decades and continues to be practiced with excellence matching international standards at Ghana's National Cardiothoracic Center.
2020
Cardiac surgery is not widely available in most developing countries, and most patients have no choice but to live in morbid conditions and managed conservatively or the few who are referred abroad for surgical procedures costs the respective countries millions of hard earned foreign currency. The World Health Organization projects that over the next ten years the continent of Africa will experience the largest increase in death rates from cardiovascular disease. The Jakaya Kikwete Cardiac Institute (JKCI) is a government owned National Specialized and Teaching Hospital that serves patients from all the regions of the United Republic of Tanzania with a population of nearly 60,000,000 people and also serves beyond the borders (Rwanda, Burundi, DR Congo, South Sudan, Comoro, Malawi and Zambia) for advanced cardiovascular medical, intervention, vascular and open heart surgery, the Institute was established in 2015. Methods: Here we report all patients who underwent coronary artery bypass surgery grafting only performed at the Centre since its inauguration in 2015-till 2019. Data were collected for basic demography, diagnosis, investigations, clinical and surgical outcome parameters. Results: A total of 85 patients with heart diseases and underwent coronary artery bypass surgery grafting (CABG) are analysed in this study. There were 64 (75%) male and 21 (25%) female patients. Their age ranged from 41-85 years old with almost half 42 (49%) of the cohort being between the age between 61-70 years old. Most of the patients had two or more grafts and an internal mammary artery graft was used over 80% of the procedures. The overall 30-day mortality was 7.1%, incidence of stroke 0.2%, duration of mechanical ventilation was an average of 9.98 hours and intensive care unit (ICU) stay post CABG was an average of 6.48 days and nal discharge from the centre ranged from 10-16 days. Conclusion: This study has demonstrated that coronary artery bypass surgery grafting in low/middle income country is safe and feasible. A sustainable program demands highest level of governmental support as seen in this case, and a dedicated multidisciplinary team with profound know how in cardiac pathologies. Furthermore, a need for good local data to know the prevalence of coronary disease is mandatory to determine the magnitude of coronary artery disease in each country.
Cardiac surgery in sub-Saharan Africa: a report of 3-year experience at the Douala General Hospital
Journal of Xiangya Medicine, 2017
Background: Cardiac surgery was started at the Douala General Hospital since 2012 as a result of a North-South collaboration between Cameroon and Belgium. Five cardiac surgery missions have been carried out since then. This work aimed at assessing three years of this initial experience. Methods: We carried out a cross-sectional descriptive study between November 2012 and March 2016. We reviewed the case records of all patients with heart disease, and with an indication for surgery. Results: A total of 45 patients with heart diseases who had an indication for surgery were retained for this study. There were 23 women and 22 men. Of these, 27 patients benefited from surgical intervention. Their mean age was 41±18 years (range, 14 to 85 years). The most common physical sign was heart murmur in 29 (64.4%) patients. Valvular Heart diseases were the most frequent in 32 (71.1%) patients, which were predominantly rheumatic heart diseases (RHD) in 25 (55.6%) patients. The most frequent surgical procedures were valve replacement with prosthesis, followed by repairs of congenital abnormalities. Mechanical prosthesis were mostly used (8/12 cases). Short-term intra-hospital mortality was 7.4%. The main cause of death was acute ventricular failure. Conclusions: The pilot phase of the cardiac surgery program at the General Hospital of Douala (DGH) was successful. Patients could be operated at a lower cost locally. Efforts must be made for the creation of an autonomous local team.
Cardiac surgical experience in northern Nigeria : cardiovascular topic
CVJA, 2012
A pilot study was undertaken to determine the feasibility of establishing a heart surgery programme in northern Nigeria. During three medical missions by a visiting US team, in partnership with local physicians, 18 patients with heart diseases underwent surgery at two referral hospitals in the region. Sixteen (88.9%) patients underwent the planned operative procedure with an observed 30-day mortality of 12.5% (2/16) and 0% morbidity. Late complications were anticoagulant related in mechanical heart valve patients and included a first-trimester abortion one year postoperatively, and a death at two years from haemorrhage during pregnancy. This has prompted us to now consider bioprosthetics as the valve of choice in women of childbearing age in this patient population. This preliminary result has further stimulated the interest of all stakeholders on the urgency to establish open-heart surgery as part of the armamentarium to combat the ravages of heart diseases in northern Nigeria.
The development of cardiac surgery in West Africa-the case of Ghana
panafrican-med-journal.com
West Africa is one of the poorest regions of the world. The sixteen nations listed by the United Nations in this sub-region have some of the lowest gross domestic products in the world. Health care infrastructure is deficient in most of these countries. Cardiac surgery, with its heavy financial outlay is unavailable in many West African countries. These facts notwithstanding, some West African countries have a proud history of open heart surgery not very well known even in African health care circles. Many African health care givers are under the erroneous impression that the cardiovascular surgical landscape of West Africa is blank. However, documented reports of open-heart surgery in Ghana dates as far back as 1964 when surface cooling was used by Ghanaian surgeons to close atrial septal defects. Ghana's National Cardiothoracic Center is still very active and is accredited by the West African College of Surgeons for the training of cardiothoracic surgeons. Reports from Nigeria indicate openheart surgery taking place from 1974. Cote D'Ivoire had reported on its first 300 open-heart cases by 1983. Senegal reported open-heart surgery from 1995 and still runs an active center. Cameroon started out in 2009 with work done by an Italian group that ultimately aims to train indigenous surgeons to run the program. This review traces the development and current state of cardiothoracic surgery in West Africa with Ghana's National Cardiothoracic Center as the reference. It aims to dispel the notion that there are no major active cardiothoracic centers in the West African sub-region.
Objective The profile, success and progression of patients undergoing coronary artery bypass graft at the institute has not adequately been reviewed. Coronary artery bypass graft though a widely performed procedure in developed countries, it is uncommon procedure in a few centers found in developing countries. The procedure is skill and expertise demanding. The study aimed to evaluate patients’ characteristics, number and disposition of patients after coronary artery bypass graft surgery. Methods This was a retrospective study that enrolled all patients who underwent coronary revascularization at the centre from May 2016 through November 2022. Patients’ demographic was entered into a structured data sheet, excluded were those whom their surgical and clinical details could not be retrieved. Preoperative clinical details, intraoperative and postoperative patients’ profile were recorded and entered into a data sheet in SPSS version 20 program and analyzed; Chi square (χ2) was used to c...
Tabula viva chirurgi: a living surgical document
Cardiovascular journal of South Africa : official journal for Southern Africa Cardiac Society [and] South African Society of Cardiac Practitioners, 2016
Aim: The purpose of this article is to present the results of a private cardiac surgical practice. This information could also serve as a hermeneutical text for new wisdom. Methods: A personal database of 1 750 consecutive patients who had had coronary artery bypass graft (CABG) surgery was statistically analysed. Mortality and major morbidity figures were compared with large registries. Risk factors for postoperative death were determined. Results: Over a period of 12 years, 1 344 (76.8%) males and 406 (23.2%) females were operated on. The observed mortality rate was 3.03% and the expected mortality rate (EuroSCORE) was 3.87%. After stepwise logistic regression, independent risk factors for death were urgency (intra-aortic balloon pump), renal impairment (chronic kidney disease, stage III), re-operation and an additional procedure. Apart from the 53 deaths, another 91 patients had major complications. Conclusion: Mortality and morbidity rates compared favourably with other international registries. Mortality was related to co-morbidities. This outcome contributes to a hermeneutical understanding focusing on new spiritual wisdom and meaning for the surgeon.
East and Central African Journal of Surgery, 2010
Background: Establishing a cardiac unit in developing countries is usually difficult as it is associated with many obstacles of both expertise and financial constraints and more alarming is the mortality rate that may be high. Even after success in the initial stage sustainability of such program is a dilemma. The aim of this study was to determine pattern of disease profile, type of cardiac surgery done and the overall outcome. Methods: All patients who underwent cardiac operation at the centre were prospectively recruited. Patients' demography and disease characteristics as demonstrated at echocardiography and its confirmation at operation were recorded. Peri-operative factors were the measurable statistics that determined the overall patients' outcome. All data were entered and analyzed using a spss11.5 window program. Results: A total of 105 cases of cardiac surgery were done 21% were male and 79% were females. Mean age was 19.4±12.3. The majority of cases were due to Rheumatic heart diseases (47.6%), congenital heart disease (35.2%), myxomatous valvular degeneration (16.2%) and pericardial disease 1%. Mitral valve disease was the commonest cause of cardiac disease (58.1%). Prolonged duration of aortic cross-clamp and total operation time were associated with prolonged intensive care stay and poor patients' outcome respectively (p<0.05). While, ventricular dysfunction and total cardiopulmonary bypass time were not. The overall mortality rate was 13.3%. Majority of all death (64.3%) followed mitral valve repair. Conclusion: The majority of patients (86.7%) who underwent cardiac surgery had full recovery. The mortality of (13.3%) is probably comparable to other settings. The diversity of spectrum of cardiac disease found elsewhere is also found in our community and therefore need to increase community awareness. Mitral valve repair deserve a special entity that requires skills and expertise. The mere presence of suboptimal ventricular dysfunction is probably not a contraindication to cardiac operation. The duration of aortic cross-clamp and total operation time were determinant of postoperative outcome.
West Indian Medical Journal, 2017
Objectives: A detailed analysis of coronary artery bypass graft (CABG) surgical cases performed at the University Hospital of the West Indies (UHWI) has never been conducted. We present the demographic profile, clinical characteristics, and outcome of cases performed during the period March 2010 to March 2016. Methods: Data from consecutive CABG surgeries performed during the study period were collected prospectively, entered into a computerized database and then analyzed. Outcome measures were 30-day operative mortality, ICU length of stay (ICU LOS) and total postoperative length of stay (PostOp LOS). Results: Of the 190 patients comprising the study population, 68.9% were males, and mean age (SD) was 61.3 (±10.2) years. The most frequent co-morbidities and risk factors were hypertension (82.1%) and diabetes (55.3%), cigarette smoking (33.7%) and hyperlipidaemia (89%). Left ventricular ejection fraction (LVEF) was found to be grades 1(good), 2(moderate), and 3(poor) in 50%, 44.2%, and 5.8% of patients, respectively. The majority (83%) were diagnosed with triple vessel disease. The crude, unadjusted 30-day mortality rate was 8.4%. Using the Canadian Risk Index Model, the mortality rates were: low risk (0-3), 5.5%; medium risk (4-7), 14.3%; and high risk (>8), 100%. The median ICU LOS and median postoperative LOS were 3 days (IQR, 2-4), and 8 days (IQR, 6-11), respectively. Logistic regression analysis revealed that grade 2 LVEF and urgent/emergent operations were predictors of mortality, female gender predictive of prolonged ICU LOS, and advanced age and female gender of borderline significance for prolonged PostOp LOS. Conclusion: This analysis of outcome of CABG cases performed at the UHWI provides an indication of current performance and serves as a benchmark against which future studies may be compared to determine the efficacy of future quality improvement initiatives.
AMJ, 2022
Coronary artery bypass grafting (CABG) is a major surgical operation where atheromatous blockages in a patient’s coronary arteries are bypassed with harvested venous or arterial conduits. Post-CABG mortality has been associated with multiple patient factors such as advanced age, preoperative renal dysfunction, diabetes, low preoperative Ejection Fraction (EF), stroke, carotid artery disease, dysrhythmias, concomitant valvular disease and multiple other comorbidities. To assess the mortality rate and discuss the possible risk factors associated with mortality following CABG. A cross sectional study was conducted in the Cardiac Center in Erbil, Kurdistan region of Iraq from June 2020 to March 2021. Data was collected from case files of 200 patients in the hospital records and follow up data was obtained after a 6-15-month period by interviewing the patients directly. Data were analysed using the Statistical Package for Social Sciences version 23 (SPSS, IBM, Armonk, NY, USA). The mortality rate after CABG was 8.5% in the study duration, with the majority being in the 50-59 age group. Female gender, left ventricular dysfunction, hyperlipidemia, double vessel disease and triple vessel disease, valvular disease and concomitant valve surgery were identified as risk factors for mortality in the postoperative period. More efforts should be directed towards preventing and controlling cardiovascular risk factors to decrease the prevalence and impact of CAD in our community.