A Global Systematic Review of Open-Heart Valvular Surgery in Resource-Limited Settings

Background Many obstacles challenge the establishment and expansion of cardiac surgery in low- and middle-income countries, despite the unmet cardiac surgical needs. One challenge has been providing adequate follow-up care to monitor anticoagulation, manage morbidity, and prevent mortality. Here, we provide a systematic review of outcomes after valvular cardiac surgery, focusing on strategies for prolonged follow-up care in resource-constrained settings. Methods Studies published between 2012 and 2022 were collected from Embase and the Cochrane Library. Article inclusion criteria were adolescent and adult patients, open-heart valvular surgery, and analysis of at least one postoperative outcome at least 30 days postoperatively. Studies focused on pediatric patients, pregnant patients, transcatheter procedures, in-hospital outcomes, and non-valvular surgeries were excluded. Descriptive statistics were assessed and articles were summarized after abstract screening, full-text review, and data extraction. Results Sixty-seven relevant publications were identified after screening. The most commonly studied regions were Asia (46%), Africa (36%), and Latin America (9%). Rheumatic heart disease was the most commonly studied valvular disease (70%). Reported outcomes included mortality, surgical reintervention, and thrombotic events. Follow-up duration ranged from 30 days to 144 months; eleven studies reported a follow-up length of 12 months. Conclusions Addressing the unmet cardiac care needs requires a multifaceted approach that leverages telemedicine technology, enhances medical infrastructure, and aligns advocacy efforts. Learning from the cost-effective establishment of cardiac surgery in low- and middle-income countries, we can apply past innovations to foster sustainable cardiac surgical capacity.