Open-Heart Surgery in Low-Income Settings: The Experience of <i>Salam</i> Centre for Cardiac Surgery in Sudan (2007–2019)

Abstract

Background: Despite the need for cardiac surgery in Sub-Saharan Africa, access is still very limited. Active since 2007, the Salam Centre for Cardiac Surgery, run by EMERGENCY NGO and co-financed by the Sudanese government, offers heart surgery free of charge. Methods: Retrospective cohort study of 8369 consecutive patients undergoing open-heart surgery between 2007 and 2019, from Sudan (81%) and from neighbouring countries (19%). Findings: Rheumatic heart disease (RHD) was prevalent in 80% of adults (median age 28, Q1-Q3 20-37); with 43% isolated mitral, 11% aortic and 46% multiple valve procedures. Out of the 1396 (17%) patients with congenital heart disease (CHD), 74% were children (< 15 years). Continuity over the years and the low hospital/ 30 days mortality (2·9% RHD; 3·4% CHD) reflect the quality of in-hospital care. Outpatient and oral anticoagulation clinics ensured care after discharge, leading to a 5-years loss-to-follow-up for RHD patients of 18% and a 5-years overall survival of 89.6% (95% CI: 88.9-90.3), with values over 90% for MV and AV surgeries . The programme has also provided training for more than 400 local healthcare workers (2013–2019). Interpretation: The overall favorable results strongly support the original hypothesis that quality, gratuity, and long-term commitment represent the key elements in the collaboration between a humanitarian independent NGO and institutional actors, paving the way for wider, sustainable developments. Funding: The SALAM Centre is funded by EMERGENCY-NGO and by the Sudanese Government. The average Government Contribution in 2007-2019 amounts to 32% of the project’s overall costs, reaching 50% in 2014-2017. Declaration of Interest: We declare no competing interests. Ethical Approval: The institutional ethics board of the University of Milan have approved this study and, due to the nature of retrospective chart reviews, waived the need for informed consent from individual patients.