Abstract

Background: Congenital Heart Disease (CHD) is one of the leading causes of infant death from congenital malformations. The incidence of CHD is about 8 cases per 1,000 live births with a higher absolute number in African countries. The fifty-four countries in Africa have an estimated total annual CHD birth prevalence of 300,486 cases. Out of this 51.4% of the continental birth prevalence occurs in only seven African countries. CHD primarily remains a paediatric health issue in Africa because of the deficient health-care systems. Insufficient infrastructure adds to the list of obstacles to Open-Heart Surgery (OHS) in this region. Africa has one Cardiac-centre for 50 million inhabitants. Komfo Anokye Teaching Hospital (KATH), Kumasi provides surgical and perioperative care to CHD patients going for OHS from the Ashanti region, other regions of Ghana as well as neighbouring countries. The purpose of this study was to describe the types of palliative surgical procedures performed in the last ten years, to compare the change in trends before and after 2014, to assess the efficiency and quality of palliative care provided patients with congenital heart diseases in a low resource setting at KATH, Kumasi.

Methods: A retrospective study from 2007 to 2016 involved 118 patients from either sex, undergone OHS under general anaesthesia after obtaining approval from Committee on human research publications and ethics

Results: The average ICU Length of Stay (LOS) in days and average hospital LOS in days were (3.15±2.37 and 1.37±2.85), and (6.86±3.50 and 4.21±3.67) before 2014 and after 2014 respectively. Increase in the number of on-table extubations from 7.2% to 39.7% whereas a decrease in average mechanical ventilation time from 82.35±11.71 to 23.49±7.93 hrs in group after 2014. Postoperative chest tube drainage in the first 48 hours decreased from 133±28.4 to 95±20.3 ml and re-exploration from 11.6% to 2.7%, which reduced postoperatively bleeding and re-exploration with the use of tranexamic acid after 2014.

Conclusion: The surgeries that have been performed provided good palliation for congenital heart diseases in this environment thus there is a need for a paradigm shift to achieve long-term sustainability of OHS in Africa.

Keywords: Congenital heart disease; Kumasi; Open-heart surgery; Palliative procedure; paradigm shift

Abbreviations: CHD: Congenital heart disease; WHO: World Health Organisation; RHD: Acquired Rheumatic Heart Disease; UNDP: United Nations Development Program; NCD: Non-Communicable Diseases; OHS: Open-Heart Surgery; KATH: Komfo Anokye Teaching Hospital; VSD: Ventricular Septal Defect; DORV: Double Outlet Right Ventricle; ACC: Aristotle’s Comprehensive Complexity; TXA Tranexamic Acid; BT: Blalock-Taussig