Pattern and outcome of pediatric patients referred abroad for cardiac surgery from a tertiary hospital in the Niger Delta region of Nigeria

Abstract

Background: The high cost of open-heart surgery, poor funding, and lack of adequate facilities and workforce are some of the challenges facing Nigerian children with structural heart diseases in need of cardiac surgery. This study was undertaken to highlight the pattern and outcome of those referred abroad for cardiac surgery from a tertiary institution in the Niger Delta region of Nigeria. Materials and Methods: Thirty-five children attending the pediatric cardiology clinic of the Niger Delta University Teaching Hospital over a 5-year period (February 01, 2012 to January 31, 2017) were enrolled in the study. A cardiac register was opened at the onset of this program and those in need of cardiac surgery were recruited to a list. When space was available, they were sent to Italy for corrective surgery. Results: Over the 5-year period, 13 (37.1%) of the 35 patients seen at the cardiology clinic had cardiac surgery abroad. Ventricular septal defects and tetralogy of Fallot were the most common structural heart diseases seen. The types of surgeries performed included patent ductus arteriosus ligation, Glenn shunt, embolization of aortopulmonary collaterals, closure of atrial and ventricular septal defects, pulmonary aortoplasty, mitral valve replacement, and total intracardiac repair of tetralogy of Fallot. There was an average duration of 6.77 ± 3.14 months between initial presentation and surgical intervention. There was no in-hospital mortality, but there was a case fatality of 15.4% after 30 days postsurgery. Causes of death were cardiac arrhythmias and infective endocarditis. Eight of the 35 children died giving a mortality rate of 22.9%. Six (75%) died awaiting surgery. Conclusion: Financial aid from nongovernmental organizations is insufficient to meet the growing demand for surgical intervention of pediatric cardiology patients in Nigeria. Reduction in the cost of open-heart surgery, equipping surgical facilities, and training local medical personnel could help to increase access to pediatric cardiac surgical care in Nigeria.