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Characterizing Congenital Heart Surgery In Low- And Middle- Income Countries: Capacity, Barriers, And Opportunities
Amisha Paul, BS, BA1, Sahithi Bhavana, MBBS2, Vaishnavi Balaji, BSA, BS3, Lukman A. Faniyi, MD4, Anusha Jegatheeswaran, MD, PhD, FRCSC5, Tara Karamlou, MD, MSc6, Jeffrey P. Jacobs, MD, FACS, FACC, FCCP7, Karl F. Welke8.
1Case Western Reserve University School of Medicine, Cleveland, OH, USA, 2Akron Children’s Hospital, Akron, OH, USA, 3Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 4Cleveland Clinic Akron General, Akron, OH, USA, 5Great Ormond Street Hospital, London, United Kingdom, 6Akron Children’s and Cincinnati Children’s Hospital Medical Center, Akron, OH, USA, 7University of Florida, Gainesville, FL, USA, 8Atrium Health Levine Children's Hospital, Wake Forest University School of Medicine, Charlotte, NC, USA.
Objective(s): Over 1.35 million children are born with congenital heart disease annually. Most births occur in low- and middle-income countries(LMICs). Despite this, little is known about congenital heart surgery(CHS) infrastructure in LMICs. This study is designed to identify CHS centers in LMICs and detail their resources and barriers.
Methods: Validated, large-language-model-assisted methodology identified LMIC CHS centers. A structured survey assessing workforce, surgical volume, procedural capacity, outcomes tracking, and barriers to care was distributed.
Results: We identified 426 potential centers across 103/121 LMICs(Figure 1A). Survey responses were received from 36 centers in 27 countries (Africa(n=10), Asia(n=6), South/Latin America(n=8), and Europe(n=3)). Annual CHS volume varied widely(2 to 3,500 cases/year). While 75%(27/36) of centers performed neonatal cardiac surgery, capacity was lower in African centers(4/12=33%) compared to other regions(23/24=96%). Most centers tracked outcomes internally(23/36=64%); a minority(13/36=36%) reported to a national or international database. All respondents(36/36=100%) identified at least one major structural barrier to care delivery, while 83%(30/36) identified co-occurring barriers.(Figure 1B) The most commonly requested supports were training programs, equipment and consumables, and ICU capacity-building. Only 31%(11/36) of centers reported no reliance on visiting surgical teams.
Conclusions: This survey is the first systematic snapshot of CHS across LMICs. Regional variation exists in surgical volume and resources. Barriers are consistent and multifactorial. These findings establish a foundation for upcoming structured interviews, targeted capacity-building, and an open-access global database of CHS centers.
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