Nigerian Journal of Cardiovascular & Thoracic Surgery

LETTER TO EDITOR
Year
: 2019  |  Volume : 4  |  Issue : 1  |  Page : 22-

The Cape Town Declaration on Access to Cardiac Surgery in the Developing World: Is it a true reflection of the needs of Sub-Saharan Africa?


Robin H Kinsley1, Darshan Reddy1, Charles Yankah2,  
1 Department of Cardiothoracic Surgery, Lenmed Ethekwini Hospital, Durban, South Africa
2 German Heart Centre, Berlin, Germany

Correspondence Address:
Charles Yankah
German Heart Centre, Berlin
Germany




How to cite this article:
Kinsley RH, Reddy D, Yankah C. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World: Is it a true reflection of the needs of Sub-Saharan Africa?.Niger J Cardiovasc Thorac Surg 2019;4:22-22


How to cite this URL:
Kinsley RH, Reddy D, Yankah C. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World: Is it a true reflection of the needs of Sub-Saharan Africa?. Niger J Cardiovasc Thorac Surg [serial online] 2019 [cited 2022 Oct 4 ];4:22-22
Available from: http://www.nigjourcvtsurg.org/text.asp?2019/4/1/22/268465


Full Text



To the Editor,

We read with interest the article by Zilla et al. entitled “The Cape Town Declaration on Access to Cardiac Surgery in the Developing World.”[1] The declaration never mentions the burden of congenital heart disease in Africa. Rather, corrective “lifesaving surgery” for rheumatic heart disease (largely valve replacement) is emphasized. Is this an oversight? Expensive valve replacement surgery in Africa is a disaster and should not be advocated. Anticoagulation in low- and middle-income countries is hopelessly inadequate; penicillin prophylaxis is variable. By contrast, mitral valve repair is rarely performed [2] because of fly in missions and lack of skills. Even the results of mitral valve repair for rheumatic valvular disease are suboptimal and are inferior to the results of repair for degenerative mitral valve disease.[3] Zille et al. estimated that 300 operations per million of the population are required in the developing world. Is this only for rheumatic heart disease or a combination of rheumatic and congenital heart diseases?

Three hundred thousand children are born annually in the African continent with congenital heart disease. Most of them will require surgical correction, which is extremely efficacious. Many will require further operations, for example, pulmonary valve replacement post Fallot's tetralogy. Some patients survive to the teens or even young adulthood without surgery, but subsequently need operation. Hence, the number escalates year on year.

The sub-Saharan Africa (SSA) is faced with enormous demographic and economic challenges. The incidence of cardiac diseases in children approximates that of human immunodeficiency virus infection,[4] but noncommunicable diseases are simply not a government priority. Thus, unfortunately, only 2% of the pediatric patients in the SSA have access to surgical treatment.[2],[5]

In our view, the initial solution would be the establishment of regional cardiac hubs, which, through economics of scale, would reduce costs. Importantly, there should be global standards of training, education, and certification with continued competence. Because of the lack of political priority, some form of private–public integration is mandatory.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Zilla P, Bolman RM, Yacoub MH, Bayersdorf F, Sliwa K, Zuhlke L, et al. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World. Cardiovasc Jour of Africa 2018;29:256-259.
2Yankah C, Fynn-Thompson F, Antunes M, Edwin F, Yuko-Jowi C, Mendis S, et al. Cardiac surgery capacity in sub-Saharan Africa: Quo vadis? Thorac Cardiovasc Surg 2014;62:393-401.
3Duran CM, Gometza B, Saad E. Valve repair in rheumatic mitral disease: An unsolved problem. J Card Surg 1994;9:282-5.
4Zilla P, Yacoub M, Zühlke L, Beyersdorf F, Sliwa K, Khubulava G, et al. Global unmet needs in cardiac surgery. Glob Heart 2018;13:293-303.
5Metras D, Ouezzin-Coulibaly A, Ouattara K, Chauvet J, Longechaud A, Millet P, et al. Open-heart surgery in tropical Africa. Results and peculiar problems of the 1st 300 cases of extracorporeal circulation performed in Abidjan. Presse Med 1983;12:621-4.