Indian Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"End-stage paediatric heart failure in low- and middle-income countries: challenges in surgical management.","authors":"Komarakshi Balakrishnan","doi":"10.1007/s12055-024-01853-z","DOIUrl":"10.1007/s12055-024-01853-z","url":null,"abstract":"<p><strong>Purpose: </strong>To define the challenges faced in the surgical treatment of end-stage heart failure in low- and middle-income countries and offer possible solutions.</p><p><strong>Methods: </strong>The World Bank definition of low- and middle-income countries (LMIC) is gross national income less than US $1085 and US $4255 respectively. In this list, India is the only country with a significant paediatric heart transplant and mechanical circulatory support programme. Hence, the Indian experience was used as an example in this study. A total of 141 children less than or equal to 18 years underwent a heart transplant over a 10-year period in a single surgical unit. The youngest was 8 months old. Twenty children were younger than 5 years of age and 58 were less than 10 years. The major problems to overcome were shortage of paediatric donors, challenges in organ transport, challenges in keeping sick recipients alive while awaiting a donor heart and dealing with cost implications and long-term care. A third of these patients were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) I or II. Fourteen percent were on mechanical circulatory support prior to transplant. Hospital mortality was defined as death within 90 days of transplant. The follow-up was up to 10 years.</p><p><strong>Results: </strong>The 90-day survival was 85.11%. The risk factors for hospital mortality were low INTERMACS (odds ratio - OR 0.3, <i>p</i> ~ 0.004), high creatinine (OR 3.6, <i>p</i> ~ 0.06) and high pretransplant right atrial pressure more than 15 mm Hg (OR 4.7, <i>p</i> ~ 0.03). The Kaplan-Meier survival curve showed a survival of over 70% at 10-year follow-up. The donors were typically older and the donor to recipient weight ratio was also significantly more than in published literature. Donor age more than 25 years had poorer outcomes long term. The economic challenges of running a programme in LMIC economies are enormous and need several innovative solutions including routine use of commercial aircrafts for organ transport.</p><p><strong>Conclusions: </strong>Despite numerous challenges, a successful paediatric heart transplant programme is possible in LMIC countries with outcomes comparable to published data.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-024-01853-z.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"768-783"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of pediatric cardiac surgery in Indonesia-a thousand islands and a handful of centers.","authors":"Budi Rahmat, Putu Wisnu Arya Wardana","doi":"10.1007/s12055-024-01793-8","DOIUrl":"10.1007/s12055-024-01793-8","url":null,"abstract":"<p><p>Providing good medical access for patients with congenital heart disease (CHD) is still a significant issue in most developing countries, including Indonesia. With approximately 50,000 newborns with CHD annually, the development of pediatric cardiac surgery in Indonesia needs to be intensified. After the establishment of the National Cardiovascular Center Harapan Kita in 1985, followed by other centers, the development of pediatric cardiac surgery in Indonesia has surpassed several milestones in treating CHD. However, some main problems, including lack of human, medical, and financial resources, lack of education centers, and uneven distribution of the centers, still need to be solved urgently with the cooperation of medical health providers, the government, and the stakeholders.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"807-811"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing the regressed left ventricle in late presenting TGA.","authors":"Dhananjay Prakash Malankar, Rajesh Sharma","doi":"10.1007/s12055-024-01880-w","DOIUrl":"10.1007/s12055-024-01880-w","url":null,"abstract":"<p><strong>Introduction: </strong>The arterial switch operation (ASO) remains the gold standard of care for neonates with transposition of great arteries (TGA). However, the timing and the choice of surgical procedure in children presenting late with transposition of great arteries with intact ventricular septum (TGA/IVS) and regressed left ventricle (rLV) is still a matter of debate. Evolution of the concept of left ventricular re-training with different techniques has led to a paradigm shift in the management of this subset of late presenting 'simple' transposition.</p><p><strong>Materials and methods: </strong>Literature review was done in Pubmed and Scopus to identify relevant articles pertaining to the pathophysiology and different treatment options for late presenting TGA with intact ventricular septum with an aim of writing a review on the subject.</p><p><strong>Results: </strong>Multiple treatment options have been reported in the literature varying from a single-stage operation to multi-stage procedure to achieve good long-term result. Majority are isolated case reports or case series with small number of children and only few studies have mid-term and long-term outcomes.</p><p><strong>Conclusions: </strong>In children presenting late with TGA and rLV, left ventricular re-training seems the most feasible and effective method. In hospital setups with cost constraints, other low-risk techniques can be attempted but corrective surgery will be needed in the future, thus making these procedures cost-shifting strategies rather than cost-saving procedures.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"756-767"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late presenting tetralogy of Fallot-surgical management.","authors":"Sachin Talwar, Niwin George, Vishal Vinayak Bhende, Balram Airan","doi":"10.1007/s12055-025-01949-0","DOIUrl":"10.1007/s12055-025-01949-0","url":null,"abstract":"<p><p>Late presentation of tetralogy of Fallot (TOF) poses unique diagnostic and management challenges, differing significantly from those diagnosed and treated in infancy. This review discusses the definition and natural history of late-presenting TOF, emphasizing the surgical and perioperative considerations specific to this population. We also explore the role of phlebotomy in managing polycythemic patients, a practice not universally adopted, and highlight postoperative challenges, including residual defects and complications. While discussing the surgical correction of TOF, we analyse the outcomes of specific strategies and the role of elective pulmonary valve replacement in adult patients. This comprehensive overview aims to shed light on the nuances of managing these complex cases.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"730-744"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free surgery for CHD through philanthropy-a sustainable model?","authors":"Prabhatha Rashmi Murthy, Sowmya Jandhyala, Shaun Prasanth Setty, Sreenivas Chodagam","doi":"10.1007/s12055-024-01813-7","DOIUrl":"10.1007/s12055-024-01813-7","url":null,"abstract":"<p><p>Among the multiple challenges faced by children from low- and middle-income countries (LMICs) with congenital heart disease (CHD), the economics of care remains foremost, contributing significantly to morbidity and mortality. This paper evaluates the four existing finance models available for healthcare systems and proposes a new model-the GIVE model (government, institutions and individuals, values, and engagements)-as the fifth model for global sustainable healthcare systems. The paper presents an evaluation of a chain of three paediatric cardiac hospitals in India to assess the sustainability of their philanthropy-based operational model, through which surgeries are offered completely free of cost to children with CHD. The three Sri Sathya Sai Sanjeevani Centres for Child Heart Care in India have been proponents of this philanthropic model for over a decade. From February 2013 to January 2024, 19,684 patients with CHD received surgeries at no cost. The average cost of surgery was reported to be USD (United States Dollar) 1800. A case study of one of the Sanjeevani Centres showed that 23.8% of patients were in STAT Category 3 and above, as defined by the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery, with an in-hospital mortality rate of 2.08%. The evaluation highlighted the institution's numerous strategies to enable sustainability in key aspects of operations, economics, and social impact. Despite challenges, the Sai Sanjeevani philanthropic model, which encompasses both economic and social impact, is dependable and can be replicated. The proposed GIVE model is recommended for adoption by LMICs as a global way forward to enable free CHD surgeries through sustained philanthropy, strengthened by a shared vision and collaborations.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"672-685"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric cardiac intensivists in low-middle-income countries - necessity or dispensable luxury?","authors":"Parvathi Unninayar Iyer, Krishna Subramony Iyer","doi":"10.1007/s12055-025-01928-5","DOIUrl":"10.1007/s12055-025-01928-5","url":null,"abstract":"<p><p>Pediatric cardiac intensive care (PCIC) is now a well-recognized specialty in the well-resourced developed world, and its need and utilization in optimal delivery of care for congenital heart disease (CHD) especially congenital heart surgery (CHS) is well established. The delivery of CHD care in low- and middle-income countries (LMICs) continues to face numerous challenges, not the least of which is the availability of resources to develop and maintain PCIC units and the pediatric intensivists to man them. This article explores the question as to whether reliable PCIC is feasible in LMICs and remains a necessity, or if it is dispensable. The article also looks at the current status and challenges of PCIC in resource-limited environs.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"697-703"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The single ventricle presenting late: surgical options.","authors":"Sachin Talwar, Supreet Marathe, Manan Desai, Navnita Kisku, Vishal Vinayak Bhende","doi":"10.1007/s12055-025-01948-1","DOIUrl":"10.1007/s12055-025-01948-1","url":null,"abstract":"<p><p>The term single ventricle (SV) comprises a wide variety of congenital anomalies with a structurally or functionally univentricular heart where a biventricular repair is not possible or undesirable. The surgical management of these patients is often staged and the ultimate palliation is the Fontan operation (FO). Despite advances in surgical techniques, significant challenges persist in the management of SV patients, particularly in low- and middle-income countries (LMICs), where delayed presentation and limited healthcare access are common. This review explores current management strategies for patients beyond childhood, including those who have never undergone palliation and post-Fontan patients facing long-term complications. Key topics include the surgical approaches to SV, such as pulmonary artery banding (PAB), bidirectional Glenn (BDG), and FO, with particular focus on considerations for late-presenting adults in LMICs. The disparities in healthcare resources between high-income countries and LMICs are highlighted, demonstrating that resource constraints significantly impact timely interventions and on-going follow-up care.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"745-755"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric cardiac surgical tourism in LMIC's-the paradox.","authors":"Siddartha Churchigundi Rudrappa, Raja Joshi","doi":"10.1007/s12055-025-01922-x","DOIUrl":"10.1007/s12055-025-01922-x","url":null,"abstract":"<p><p>Pediatric cardiac surgical tourism is a growing phenomenon in low-middle-income group countries, particularly India, which has emerged as a global hub for affordable and high-quality healthcare. India has become a destination for families seeking lifesaving cardiac interventions for children, driven by the prohibitive costs and long waiting lists in their home countries. However, this trend presents a paradox. While it showcases India's strengths in delivering advanced medical care at competitive costs, it simultaneously highlights systemic disparities in healthcare access within the country. This review critically examines the drivers, challenges, ethical concerns, and implications of pediatric cardiac surgical tourism in India. It also explores policy recommendations to address this paradox.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"692-696"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for congenital heart disease in Pakistan-the challenges and solutions.","authors":"Mahim Akmal Malik, Asad Saulat Fatimi, Alizeh Sonia Fatimi, Shirin Gul Suhail, Abdul Malik Sheikh","doi":"10.1007/s12055-024-01787-6","DOIUrl":"10.1007/s12055-024-01787-6","url":null,"abstract":"<p><p>Managing pediatric and congenital heart disease (CHD) in low- and middle-income countries like Pakistan requires a nuanced approach that extends beyond simply adopting management styles and guidelines developed for high-income countries. This review aims to examine the challenges associated with the surgical management of CHD in Pakistan, addressing the evolving and persistent disease burden while also offering context-specific solutions.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"812-820"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do humanitarian missions impede the progress of pediatric cardiac surgical programs in developing and under-served nations?","authors":"Tom Roland Karl, Rodrigo Soto, Rob Raylman","doi":"10.1007/s12055-024-01766-x","DOIUrl":"10.1007/s12055-024-01766-x","url":null,"abstract":"<p><p>Over the past three decades, there has been increasing interest in humanitarian pediatric cardiac surgery. While the need is undisputed, the most effective strategy remains debatable. With education, long-term sustainability, and safety as goals, we discuss the realities and possible benefits of the most frequently invoked care model, the visiting humanitarian cardiac surgical team.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"686-691"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}