Developing a cardiac surgery unit in the Caribbean: A reflection.

Autor: Angelini GD; Bristol Heart Institute, University of Bristol, Bristol, UK., Ramsingh RAE; Department of Cardiac Surgery and Cardiology, Caribbean Heart Care Medcorp, St. Clair Medical Centre, Port of Spain, Trinidad and Tobago., Rahaman NC; Department of Cardiac Surgery and Cardiology, Caribbean Heart Care Medcorp, St. Clair Medical Centre, Port of Spain, Trinidad and Tobago., Rampersad RD; Department of Cardiac Surgery and Cardiology, Caribbean Heart Care Medcorp, St. Clair Medical Centre, Port of Spain, Trinidad and Tobago., Rampersad A; Department of Cardiac Surgery and Cardiology, Caribbean Heart Care Medcorp, St. Clair Medical Centre, Port of Spain, Trinidad and Tobago., Rampersad KA; Department of Cardiac Surgery and Cardiology, Caribbean Heart Care Medcorp, St. Clair Medical Centre, Port of Spain, Trinidad and Tobago., Teodori G; Department of Cardiac Surgery and Cardiology, Caribbean Heart Care Medcorp, St. Clair Medical Centre, Port of Spain, Trinidad and Tobago.
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2020 Nov; Vol. 35 (11), pp. 3017-3024. Date of Electronic Publication: 2020 Aug 21.
DOI: 10.1111/jocs.14965
Abstrakt: Background and Aim: Access to specialized cardiac surgery is a problem in emerging countries. Here, we reflect on the approach we used to establish a cardiac surgery unit in Trinidad and Tobago.
Methods: The program started in 1993 with monthly visits by a team from Bristol Heart Institute. A group of local doctors, nurses, and perfusionists were identified for training, and a senior nurse moved to the island to start a teaching program. The visiting support was gradually reduced, and the local team gained independence in managing the service in 2006.
Results: The initial low volume surgery increased to around 380 cases a year with the implementation of comprehensive service in 2006. Most patients required coronary artery bypass graft (CABG). In-hospital mortality declined from 5% in the nascent years to below 2% thereafter. In the last 5 years (2015-2019), 1764 patients underwent surgery (mean age 59.6 ± 10.8 years, 66% male). The majority were East-Indian-Caribbean (79.1%) or Afro-Caribbean (16.7%), half had diabetes, and two-thirds hypertension (EuroScore II 1.8 ± 1.9). The majority (1363 patients) underwent CABG (99.5% off-pump; conversion to on-pump 1.5%). The mean number of grafts was 2.5 ± 0.7 with 98.5% and 23.1% receiving one and two or more arterial grafts, respectively. In-hospital mortality was 1.1%, re-exploration for bleeding 2%, stroke 0.1%, mediastinitis 0.2%. The length of the postoperative hospital stay was 5.8 ± 2 days.
Conclusion: Frequent outside visits complemented by training in an overseas center, and transfer of knowledge proved to be an effective strategy to develop a cardiac surgery unit in an emerging country with results comparable to accepted international standards.
(© 2020 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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