Global Unmet Needs in Cardiac Surgery

Peter Zilla*, Magdi Yacoub, Liesl Zühlke, Friedhelm Beyersdorf, Karen Sliwa, Gennadiy Khubulava, Abdelmalek Bouzid, Ana Olga Mocumbi, Devagourou Velayoudam, Devi Shetty, Chima Ofoegbu, Agneta Geldenhuys, Johan Brink, Jacques Scherman, Henning du Toit, Saeid Hosseini, Hao Zhang, Xin Jin Luo, Wei Wang, Juan MejiaTheodoros Kofidis, Robert S.D. Higgins, Jose Pomar, R. Morton Bolman, Bongani M. Mayosi, Rajhmun Madansein, Joseph Bavaria, Alberto A. Yanes-Quintana, A. Sampath Kumar, Oladapo Adeoye, Risenga Frank Chauke, David F. Williams

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

140 Citations (Scopus)


More than 6 billion people live outside industrialized countries and have insufficient access to cardiac surgery. Given the recently confirmed high prevailing mortality for rheumatic heart disease in many of these countries together with increasing numbers of patients needing interventions for lifestyle diseases due to an accelerating epidemiological transition, a significant need for cardiac surgery could be assumed. Yet, need estimates were largely based on extrapolated screening studies while true service levels remained unknown. A multi-author effort representing 16 high-, middle-, and low-income countries was undertaken to narrow the need assessment for cardiac surgery including rheumatic and lifestyle cardiac diseases as well as congenital heart disease on the basis of existing data deduction. Actual levels of cardiac surgery were determined in each of these countries on the basis of questionnaires, national databases, or annual reports of national societies. Need estimates range from 200 operations per million in low-income countries that are nonendemic for rheumatic heart disease to >1,000 operations per million in high-income countries representing the end of the epidemiological transition. Actually provided levels of cardiac surgery range from 0.5 per million in the assessed low- and lower-middle income countries (average 107 ± 113 per million; representing a population of 1.6 billion) to 500 in the upper-middle-income countries (average 270 ± 163 per million representing a population of 1.9 billion). By combining need estimates with the assessment of de facto provided levels of cardiac surgery, it emerged that a significant degree of underdelivery of often lifesaving open heart surgery does not only prevail in low-income countries but is also disturbingly high in middle-income countries.

Original languageEnglish
Pages (from-to)293-303
Number of pages11
JournalGlobal Heart
Issue number4
Publication statusPublished - Dec 2018
Externally publishedYes


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