Health System Needs to Establish Cardiac Surgery Centers

Vervoort, Dominique; Premkumar, Akash; Ghandour, Hiba; Kpodonu, Jacques

doi:10.1055/s-0040-1721395

Cited by 13 publications

(12 citation statements)

References 10 publications

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“…28 2.4 | Infrastructure, equipment, disposables, devices, drugs, and logistics For newly developing programs, various health system and infrastructure requirements are critical to ensure sustainability and safe and quality care. 29 New centers in LMICs are often financially constrained given the high upfront costs associated with establishing new infrastructure and may consider the use of used equipment or lower-cost items from upper-middle-income countries with growing cardiac surgical industry, such as Brazil, India, and China. However, caution should be exerted when using nonreusable or expired disposables, especially as these are often sterilized and reused or donated, as they may pose safety and durability risks for patients.…”

Section: Financial Needsmentioning

confidence: 99%

“…For newly developing programs, various health system and infrastructure requirements are critical to ensure sustainability and safe and quality care 29 . New centers in LMICs are often financially constrained given the high upfront costs associated with establishing new infrastructure and may consider the use of used equipment or lower‐cost items from upper‐middle‐income countries with growing cardiac surgical industry, such as Brazil, India, and China.…”

Section: Areas Of Concernmentioning

confidence: 99%

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Rheumatic heart disease: The role of global cardiac surgery

Vervoort

Antunes

Pezzella³

2021

Journal of Cardiac Surgery

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Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high‐income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low‐ and middle‐income countries (LMICs) and among indigenous and disenfranchised populations in high‐income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub‐Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.

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Section: Financial Needsmentioning

confidence: 99%

Section: Areas Of Concernmentioning

confidence: 99%

Rheumatic heart disease: The role of global cardiac surgery

Vervoort

Antunes

Pezzella³

2021

Journal of Cardiac Surgery

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“…Some of them include the private or co-financing model, the public–private partnership (PPP), fiscal space expansion, and development aid for health. 17 , 18 The private or co-financing model involves frugal innovation, which is defined by Zeschky et al as “good-enough, affordable products that meet the needs of resource-constrained consumers.” 19 Narayana Hrudayalaya Hospital in Bengaluru, India, is currently built on the cross-subsidization model in the private/co-financing sector. 20 They can achieve this because of economies of scale or the conveyer belt model and frugal innovation.…”

Section: Introductionmentioning

confidence: 99%

Can the Public–Private Business Model Provide a Sustainable Quality Pediatric Cardiac Surgery Program in Low- and Middle-Income Countries?

Kim

Seshadrinathan²,

Jenkins

et al. 2023

World J Pediatr Congenit Heart Surg

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Over 90% of the world's children with congenital heart disease do not have access to cardiac care. Although many models provide pediatric cardiac surgery in low- and middle-income countries, sustainability poses a barrier. We explore one model providing care for the underserved in Chennai, India, that came into existence through trial and error over 30 years across three phases. Phase 1 was a Tamilnadu state government–sponsored program that soon became unsustainable with unmet demands. Phase 2 utilized a grassroots foundation of a public–private partnership (PPP) with few donors and a hospital with suboptimal infrastructure. Phase 3 is the ongoing fine-tuning of the PPP model, with upgraded infrastructure and a well-trained team. Through indigenization, an average cardiac surgery costs Rupees (Rs.) 1,80,000 ($2400). The government funds Rs. 60,000 to 80,000 ($800-$1066.67), and the rest is funded through the fund pool. The goal is to perform 100 free surgeries annually by maintaining a fund pool of Rs. 50 lakhs ($66,666.67), which supplements government funds. This ensures equitable distribution of funds with no compromise on resources (disposables, single-use cannulas, etc). Our model ensures the dignity of the patient, fair compensation for workers, and is practical, affordable, and easily adaptable. Thus far, this model provided free cardiac surgery for 357 children from Risk Adjusted Congenital Heart Surgery Score of 1 to 4, with an overall mortality of 2.73%. The prerequisites for this model are having a “spark plug,” a dedicated surgical team, a partnership with state-of-the-art infrastructure, and a steady flow of funds.

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“…Therapeutic approaches for many complex diseases have changed from a discipline-specific approach to a multidisciplinary decisional process over the past 20 years. This has led to the development of highly specialised centres for cardiovascular diseases, 1 oncology, 2,3 and hepato-pancreato-biliary (HPB) 4 diseases. Combining expert opinion with high-quality evidence, centralised multidisciplinary care has been shown to result in superior outcomes, lower costs and higher patient satisfaction.…”

Section: Introductionmentioning

confidence: 99%