Ten years of pediatric congenital heart disease surgery in a Caribbean nation

Abstract

Background: Socioeconomical limitations in developing countries make congenital heart disease surgery (CHDs) a challenge that often relays on humanitarian efforts. We aimed to describe the evolution of an established pediatric CHDs program in the Dominican Republic and the impact of international medical missions (IMM) on its sustainability. Methods: Data of cases operated from 2009 to 2018 were analyzed using Pearson's chi-squared test to study trends between a 5-year implementation period (T1) January 2009–December 2013, and subsequent consolidation (T2) January 2014–December 2018. Results: 1344 consecutive patients were intervened: T1 ​= ​278 (21%), age 7 ​± ​5 years, F 51%, mean 56 cases/year; T2 ​= ​1066 (79%), age 5 ​± ​4 years, F 49%, mean 213 cases/year (p ​2 interventions occurred at a mean of 11/year, and 27/year during T2 (p ​< ​0.05); there was an increase in operated children <1 year of age [T1 ​= ​32 (12%) vs. T2 ​= ​299 (28%) p ​= ​0.0001]. During T1, IMM cases accounted for 198 (71%) and 92 (9%) during T2 (p ​< ​0.001). Yearly mortality varied in parallel to case complexity, however no difference in cumulative mortality was observed T1 vs. T2 (figure). Conclusions: In this CHDs program, there was robust growth without negatively impacting outcomes while IMM participation dropped. Integration of local and regional networks may facilitate reproducing these findings.

Keywords

• Congenital heart disease
• Pediatric cardiac surgery
• Developing countries
• Epidemiology