www.thelancet.com/lancetgh 31 Published Online April 8, 2016 Haiti Cardiac Alliance, Port-au-Prince, Haiti and Burlington, VT, USA (O Robinson MPP); Partners In Health, Boston, MA, and Boston University School of Medicine, Boston, MA (G F Kwan MD); Zanmi Lasante/Partners In Health, Mirebalais, Haiti (J L Romain MD); Pediatric Cardiology Associates of Louisiana, Baton Rouge, LA, USA (M Crapanzano MD); Mount Sinai – Beth Israel Heart, Mount Sinai – Beth Israel Medical Center, New York, NY, USA (J Wilentz MD) Correspondence to: Owen Robinson, Haiti Cardiac Alliance, 47 Maple Street, Suite 320, Burlington, VT 05401, USA orobinson@haiticardiac.org A national coordinated cardiac surgery registry in Haiti: the Haiti cardiac alliance experience Owen Robinson, Gene F Kwan, Jean-Louis Romain, Michael Crapanzano, James R Wilentz Abstract Introduction Access to cardiac surgical care in Haiti is restricted for the many children and young adults with congenital and rheumatic heart disease. Before 2013, doctors and organisations independently advocated for individual patients in need of cardiac surgery; no national-level eff ort existed to coordinate surgical access. We describe the performance of Haiti Cardiac Alliance (HCA), a cross-partner collaboration founded in July, 2013, that facilitates diagnosis, surgical referral, and long-term follow-up for Haitian cardiac patients.Introduction Access to cardiac surgical care in Haiti is restricted for the many children and young adults with congenital and rheumatic heart disease. Before 2013, doctors and organisations independently advocated for individual patients in need of cardiac surgery; no national-level eff ort existed to coordinate surgical access. We describe the performance of Haiti Cardiac Alliance (HCA), a cross-partner collaboration founded in July, 2013, that facilitates diagnosis, surgical referral, and long-term follow-up for Haitian cardiac patients. Methods HCA has developed a national referral system and centralised registry for all Haitian children and young adults awa iting diagnostic evaluation, cardiac surgery, or both. All participating partners throughout Haiti can now effi ciently refer patients into this system. When cardiac surgery is indicated, HCA matches patients with surgical partners based on urgency and clinical profi le. We analysed the HCA registry to quantify referral, diagnosis, and enrolment; cardiac surgical activity; and patient mortality before and after surgery. Findings Between July, 2013, and October, 2015, HCA workers assessed more than 1000 outpatients and enrolled 410 Haitian patients into its cardiac surgery registry. Of these patients, 134 (33%) have since undergone surgery; 72 (18%) are matched and awaiting surgery in the near term; 147 (36%) are awaiting surgical matches; and 57 (14%) died on the waiting list before surgery could be arranged. By October, 2015, an additional 137 new patients were waiting for an initial assessment from a cardiologist. Of the 134 patients who underwent surgery facilitated by HCA, 49 surgeries (37%) were in Haiti, and 85 surgeries took place in seven other countries. Three surgical patients have died since surgery, for a 30-day mortality rate of 0·7% and an overall programme mortality rate by October, 2015, was 2·2%. The most common surgical indications have been ventricular septal defect (26), patent ductus arteriosus (24), and tetralogy of Fallot (23). Interpretation In Haiti, the creation of a national-level, centralised registry has facilitated the diagnosis of patients with surgical heart disease; accelerated the expansion of surgical options for these patients; and has helped to catalyse the development of permanent surgical capacity in Haiti itself. Funding Haiti Cardiac Alliance. Copyright © Robinson et al. Open Access article distributed under the terms of CC BY. Declaration of interests We declare no competing interests.