Introduction: There has been limited experience with Open Heart Surgeries(OHS) in Sub-Saharan Africa. In west Africa especially in Mali, most fledgling centers are unable to overcome the myriad of challenges encountered in establishing OHS though there is a high prevalence of surgically correctable heart diseases. The aim of this paper is to review our initial experience of our first cases in developing OHS program and discuss the challenges and prospects that need to be overcome to further develop it. Methods: A total of 6 patients who underwent OHS during the first “cardiac mission” in July 2016 were included in this retrospective study. The medical records of the patients were examined and data on age, sex, diagnosis, EuroSCORE, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted. Results: Six patients with a male to female ratio of 1, ages ranging between 12 and 35 years (mean of 22.5 ± 12 years) were studied. The mean of EuroSCORE was 6 ± 41. Pericardial patch closure of isolated atrial septal defect was performed in one patient. One patient had mitral valve repair for rheumatic mitral regurgitation consisting of chordal shortening with a tricuspid valvuloplasty. Three patients had mitral valve replacement with tricuspid valvuloplasty. Four patients had mitral valve replacement. Sixty-day mortality？was 0%. Conclusion: Safe conduct of open heart surgery in Mali Hospital setting is feasible. Grant financial aid is required for rapid growth of Open-Heart Surgery in this part of Sub-Saharan Africa.
References
[1]
Open-Heart Surgery (2012) Collins English Dictionary—Complete & Unabridged. 10th Edition. Dictionary.com.
http://dictionary.reference.com/browse/open-heartsurgery
[2]
Anyanwu, C.H., Ihenacho, H.N., Okoroma, E.O., et al. (1982) Initial Experience with Open Heart Surgery in Nigeria. Tropical Cardiology, 8, 123-127.
[3]
Adebonojo, S.A., Grillo, I.A. and Osinowo, O. (1981) Initial Experience with Open Heart Surgery at University College Hospital, Ibadan, Nigeria. Tropical Cardiology, 7, 49–54.
[4]
Adebonojo, S.A. (2012) How Viable Are the Cardiac Programmes in West Africa Today? In: Adebonojo, S.A., Ed., Development of Open Heart Surgery in West Africa: A Historical Perspective, Acecool Medical Publishers: Nigeria, Eruwa, 43-46.
[5]
Diakité, A., Sidibé, N. and Diarra, M.B. (2009) Epidemiological and Clinical Aspects of Congenital Heart Disease. Mali Médical, 24, 67-68.
[6]
Coulibaly, B., Diarra, M. and Dicko, M. (2014) Angers-Bamako Cooperation in the Context of Cardiovascular Surgery: Situation and Perspectives: Is Open Heart Surgery Feasible in Mali? Journal de la SFCTCV, 18, 55-58.
[7]
Yangni-Angate, K.H. (2016) Open heart surgery in Sub-Saharan Africa: Challenges and Promise. Cardiovascular Diagnosis and Therapy, 6, S1-S4.
https://doi.org/10.21037/cdt.2016.10.05
[8]
Jean-Francois, M. (2007) Man Seeking Humanity. Presses Rebirth, Paris.
[9]
Mvondo, C.M., Pugliese, M., Giamberti, A., Chelo, D., Kuate, L.M., Boombhi, J. and Dailor, E.M. (2016) Surgery for Rheumatic Mitral Valve Disease in Sub-Saharan African Countries: Why Valve Repair Is Still the Best Surgical Option. Pan African Medical Journal, 24, 307. https://doi.org/10.11604/pamj.2016.24.307.7504
[10]
Masuda, M., Kado, H., Tatewaki, H., Shiokawa, Y. and Yasui, H. (2004) Late Results after Mitral Valve Replacement with Bileaflet Mechanical Prostheses in Children: Evaluation of Prosthesis-Patient Mismatch. The Annals of Thoracic Surgery, 77, 913-917. https://doi.org/10.1016/j.athoracsur.2003.09.066
[11]
Cheng, D.C. (1998) Fast Track Cardiac Surgery Pathways: Early Extubation Process of Care and Cost Containment. Anaesthesiology, 88, 1429-1433.
https://doi.org/10.1097/00000542-199806000-00002
[12]
Neirotti, R.A., Jones, D., Hackbarth, R. and Paxson Fosse, G. (2002) Early Extubation in Congenital Heart Surgery. Heart, Lung and Circulation, 11, 157-161.
https://doi.org/10.1046/j.1444-2892.2002.00144.x
[13]
Falase, B., Sanusi, M., Majekodunmi, A., et al. (2013) Open Heart Surgery in Nigeria: A Work in Progress. Journal of Cardiothoracic Surgery, 8, 6.
https://doi.org/10.1186/1749-8090-8-6
[14]
Chelo, D., Nguefack, F., Ndombo, P.O., et al. (2016) Challenges of Surgical Management of Childhood Cardiac Diseases in Sub-Saharan Africa, Experience of a Pediatric Cardiology Unit in Yaounde, Cameroon. Pediatric Research, 1, 103.
[15]
Howson, C.P., Reddy, K.S., Ryan, T.J., et al. (1998) Control of Cardiovascular Diseases in Developing Countries Research, Development, and Institutional Strengthening for Control of Cardiovascular Diseases in Developing Countries. National Academy Press, Washington DC. https://www.nap.edu/read/6218/chapter/1
[16]
Pezzella, T.A. (2005) Global Expansion of Cardiothoracic Surgery. The African Challenge. African Annals of Thoracic and Cardiovascular Surgery, 1, 9-11.
[17]
Vahanian, A., Alfieri, O., Andreotti, F., et al. (2012) Guidelines on the Management of Valvular Heart Disease (Version 2012). European Heart Journal, 33, 2451-2496.
https://doi.org/10.1093/eurheartj/ehs109
[18]
Camm, J.A., Kirchhof, P., Lip, G.Y.H., et al. (2010) Guidelines for the Management of Atrial Fibrillation. ESC Guidelines. European Heart Journal, 31, 2369-2429.
[19]
Diez, C., Koch, D., Kuss, O., et al. (2007) Risk Factors for Mediastinitis after Cardiac Surgery—A Retrospective Analysis of 1700 Patients. Journal of Cardiothoracic Surgery, 2, 23. https://doi.org/10.1186/1749-8090-2-23
[20]
Nigeria Country Data Profile. World Bank. http://web.worldbank.org
[21]
Adebonojo, S.A., Grillo, I.A., Osinowo, O., Adebo, O.A., Akinyemi, O., Famewo, C.E., Idowu, A.L. and Osanyintuyi, S.O. (1981) Initial Experience with Open Heart Surgery at University College Hospital, Ibadan, Nigeria. Tropical Cardiology, 7, 49-54.
[22]
Une, D., Mesana, L., Chan, V., Maklin, M., Chan, R., Masters, R.G., et al. (2015) Clinical Impact of Changes in Left Ventricular Function after Aortic Valve Replacement. Circulation, 132, 741-747.
https://doi.org/10.1161/CIRCULATIONAHA.115.015371
[23]
Morris, J.J., Schaff, H.V., Mullany, C.J., Rastogi, A., McGregor, C.G., Daly, R.C., et al. (1993) Determinants of Survival and Recovery of Left Ventricular Function after Valve Replacement. The Annals of Thoracic Surgery, 56, 22-30.
https://doi.org/10.1016/0003-4975(93)90398-2
