Falase Bode, Sanusi Michael, Majekodunmi Adetinuwe, Animasahun Barakat, Ajose Ifeoluwa, Idowu Ariyo, Oke Adewale
Cardiothoracic Division, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
J Cardiothorac Surg. 2013 Jan 12;8:6. doi: 10.1186/1749-8090-8-6.
There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme.
This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome.
51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model.
The Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar challenges will need to be overcome by other cardiac stakeholders if other OHS programs are to be developed and sustained in Nigeria.
尽管尼日利亚结构性心脏病的患病率很高，且有大量尼日利亚患者前往国外进行心脏直视手术，但在该国建立心脏直视手术项目的成效有限。需要找出并克服尼日利亚心脏直视手术发展过程中的挑战和限制因素。本研究的目的是回顾拉各斯州立大学教学医院心脏直视手术的经验，并突出该项目发展过程中遇到的挑战。
这是一项对在我们机构接受心脏直视手术患者的回顾性研究。数据来源是一个前瞻性维护的数据库。提取的数据包括患者人口统计学信息、手术指征、欧洲心脏手术风险评估系统（EuroSCORE）评分、体外循环时间、主动脉阻断时间、并发症及患者预后。
2004年8月至2011年12月期间共进行了51例心脏直视手术。其中男性21例，女性30例。平均年龄为29±15.6岁。平均EuroSCORE评分为3.8±2.1。所进行的手术包括二尖瓣置换术15例（29.4%）、房间隔缺损修补术14例（27.5%）、室间隔缺损修补术8例（15.7%）、主动脉瓣置换术5例（9.8%）、左心房黏液瘤切除术2例（3.9%）、冠状动脉搭桥术2例（3.9%）、双向格林分流术2例（3.9%）、法洛四联症修复术2例（3.9%）和二尖瓣修复术1例（2%）。本系列中有9例死亡（17.6%）。遇到的挑战包括手术例数少、工作环境不稳定、训练有素的工作人员数量有限、难以获得实验室支持、资金支持有限以及难以摆脱心脏传教模式。
我们机构的心脏直视手术项目仍在发展中，但如果要维持该项目，就需要克服已确定的挑战。如果要在尼日利亚发展并维持其他心脏直视手术项目，其他心脏领域的利益相关者也需要克服类似的挑战。
