A New Dawn for Brazilian Pediatric Cardiac Surgery Is on the Way — Issues Around and Outside the Operating Room

Abstract

In some developing countries, congenital heart disease still stands out among the leading causes of death in the first year of life. Therefore, there is a great need to develop programs designed to improve outcomes in the diagnosis and surgical treatment of congenital heart disease in these nations, where children have always been and still are severely underserved. The Brazilian Public Health Care System demands universal access to treatment as a constitutional right. Therefore, an underfunded Pediatric Cardiac Surgery program is unacceptable since it will cost lives and increase the infant mortality rate. Additionally, poor funding decreases providers’ interest, impedes technological advances and multidisciplinary engagement, and reduces access to comprehensive care. Unfortunately, in most developing countries, Pediatric Cardiac Surgery progress is still the result of isolated personal efforts, dedication, and individual resilience. This article aims to present the current state of Brazilian pediatric cardiac surgery and discuss the structural and human limitations in developing a quality care system for children with congenital heart disease. Considering such constraints, quality improvement programs via International collaboration with centers of excellence, based on proper data collection and outcomes analysis, have been introduced in the country. Such initiatives should bring a new dawn to Brazilian Pediatric Cardiac Surgery.

Establishing a High-Quality Pediatric Cardiac Surgery Program in Post-Conflict Regions: A Model for Limited Resource Countries

“…This collaborative model leverages the strengths of both local governmental bodies and international organizations, creating a sustainable healthcare ecosystem. Our approach aligns with the "in-situ hybrid model," which has shown promise in other low-and middle-income countries (LMICs) [21,23,35,36].…”

Challenges of Congenital Heart Surgery in Brazil: It is Time to Designate Pediatric Congenital Heart Surgery Subspecialty

“…In addition, limited demand based on the lower expected surgical volume as compared to adult acquired heart diseases make these inputs expensive, resulting in low return on investment. This is surely the reason why the industry is not prioritizing these groups when developing new products [ 7 ] .…”

“…While comprehensive, DATASUS is insufficient to address the needs of the CHD population. For detailed interpretation, some centers organize their own databases or through international partnerships, seeking to evaluate results, improve the quality of local care, and generate teaching and research [ 7 , 12 - 15 ] .…”

“…1,727 of July 11, 2017 [ 20 ] , which approved the Plano Nacional de Assistência à Criança com Cardiopatia Congênita, and in the project for situational diagnosis of surgery deficits in Brazil, carried out in partnership with the Ministry of Health, Programa de Apoio ao Desenvolvimento Institucional do SUS (or Proadi) - Ministry of Health. In the educational environment, there is an untiring disposition to hold symposia and congresses, continuous publications, as well as to demand on-site solutions for services [ 7 , 21 ] . One such example is the publication of the book “Cardiologia e Cirurgia Cardiovascular Pediátrica” (Ulisses Croti, Valdester Pinto Jr, Sandra Mattos, Vera Aielo, and Valéria Moreira), 1 st edition - 2008 [ 22 ] and 2 nd edition - 2013, which contributes to the training of surgeons, clinicians, and related professionals.…”