Developing an African cardiothoracic surgery database

Abstract

Purpose: There is a paucity of dependable clinical data in most countries performing heart surgery in sub-Saharan Africa, making it difficult therefore to adequately identify and address challenges that may contribute to poor outcomes. The article aims at creating awareness and advocating for collaborative efforts for developing database for measuring cardiovascular surgical activities in Africa. Developing an African cardiothoracic surgery database with pooled datasets similar to the practice in other continents may help mitigate against these challenges and improve clinical outcomes. Methods: Through concerted efforts by electronic communication the authors working in six sub-regions of Africa have supported this initiative by providing their data on surgery of congenital and rheumatic heart diseases for evaluation. Results: 213 heart centres from 27 countries of Africa (6 sub-regions: North Africa (including the Maghreb- Algeria, Morocco and Tunesia), East Africa, The Horn, Central Africa, West Africa and Southern Africa) were identified. Of these 75 heart centres including 35 congenital and paediatric cardiac units in sub-Saharan Africa (SSA) excluding South Africa were performing heart procedures independently or with support from visiting charity heart missions. Six selected countries of SSA (population of 147,8 million) with six paediatric cardiac units performed 660 open heart surgeries (OHS) for congenital and rheumatic heart diseases in 2019 which project a ratio of 4.5 OHS/per million. In comparison to reported PASCaTS data from 2014, valve repair has increased from 10-30% and the rate of valve replacement has decreased from 90% to 70%. Conclusion: The AfriCaTS database initiative is a wake-up call for joint efforts to develop the most needed south-south cooperation for sharing cardiovascular surgical data and outcomes. A continuing educational program (online or on-site) for the personnel engaged in this project at the African centres will be necessary to achieve efficiency and sustainability. The project will positively impact on patient care, outcomes, capacity building programs, inspire reskilling in complex procedures and research. Membership to the AfroCaTS database working group is open to all heart centres in Africa.