{"id":{"repo_id":"utswmed","oai_identifier":"oai:utswmed-ir.tdl.org:2152.5/10613"},"canonical_url":"https://search.dev.ndltd.org/etd/utswmed/oai:utswmed-ir.tdl.org:2152.5/10613","repository":{"repo_id":"utswmed","name":"University of Texas Southwestern Medical Center","base_url":"https://utswmed-ir.tdl.org/server/oai/request"},"display":{"title":"Single-Center Experience of Providing Congenital Heart Surgery to Low- and Middle-Income Countries","abstract":"OBJECTIVE: The objective of this study is to analyze the demographics of congenital heart disease (CHD) patients from over 50 low- and middle-income countries (LMICs) who received care at Frontier Lifeline Hospital (FLL), a specialty cardiac center in Chennai, India, and identify the barriers and limitations they faced. METHODS: This two-part retrospective study analyzed International Quality Improvement Collaborative (IQIC) data from Boston Children's hospital and FLL data of CHD patients who received cardiac surgery from 2008 to 2020. The first part collected demographic and clinical data. The second part included interviews with organizations and physicians to identify the barriers to cardiac care faced by patients from LMICs. RESULTS: A total of 3002 patients from various LMICs received care at FLL during this period (2008-2020). Of these patients, 2087 (81%) patients received their first cardiac surgery at FLL. Majority of patients came from the following countries: Fiji (201), Uganda (194), Bahrain (185), Sri Lanka (147), and Kenya (126). Of the total, 1801 (60%) patients were 1 to 18 years old, 975 (32%) were infants, 118 (4%) were neonates, and 108 (4%) were adult congenital, with a median age of 5 years. Common procedures included ventricular septal defect closure (787; 26%) and atrial septal defect repair (700; 23%). Of the total patients, 2950 cases were assigned a Risk adjustment for congenital heart surgery (RACHS-1) score, of which RACHS-1 categories 2 (1146; 39%) and 3 (1033; 35%) comprised the majority. CONCLUSIONS: Though healthcare systems in LMICs see and acknowledge the magnitude of patients with CHD, there are many challenges for providing cardiac care locally. Often, other priorities such as communicable diseases, raging wars, and refugee crises preclude attention for children with CHD. Patients who have sought care at FLL face other difficulties, including lack of long-term commitment from foreign partners, short-term trips directed at treating "easier" cases, and logistics of continued care. While sustaining a cardiac surgical program locally in LMICs may be a worthy goal, overcoming the myriad of barriers including funding and training professionals is no easy feat. Efforts should focus on creating surgical programs that can triage patients to address RACHS-1 categories 1, 2, and 3 and centralizing programs in LMICs with referral networks (as noted in this study) to address the more complex RACHS-1 categories 4, 5, and 6.","abstract_html":"OBJECTIVE: The objective of this study is to analyze the demographics of congenital heart disease (CHD) patients from over 50 low- and middle-income countries (LMICs) who received care at Frontier Lifeline Hospital (FLL), a specialty cardiac center in Chennai, India, and identify the barriers and limitations they faced. METHODS: This two-part retrospective study analyzed International Quality Improvement Collaborative (IQIC) data from Boston Children's hospital and FLL data of CHD patients who received cardiac surgery from 2008 to 2020. The first part collected demographic and clinical data. The second part included interviews with organizations and physicians to identify the barriers to cardiac care faced by patients from LMICs. RESULTS: A total of 3002 patients from various LMICs received care at FLL during this period (2008-2020). Of these patients, 2087 (81%) patients received their first cardiac surgery at FLL. Majority of patients came from the following countries: Fiji (201), Uganda (194), Bahrain (185), Sri Lanka (147), and Kenya (126). Of the total, 1801 (60%) patients were 1 to 18 years old, 975 (32%) were infants, 118 (4%) were neonates, and 108 (4%) were adult congenital, with a median age of 5 years. Common procedures included ventricular septal defect closure (787; 26%) and atrial septal defect repair (700; 23%). Of the total patients, 2950 cases were assigned a Risk adjustment for congenital heart surgery (RACHS-1) score, of which RACHS-1 categories 2 (1146; 39%) and 3 (1033; 35%) comprised the majority. CONCLUSIONS: Though healthcare systems in LMICs see and acknowledge the magnitude of patients with CHD, there are many challenges for providing cardiac care locally. Often, other priorities such as communicable diseases, raging wars, and refugee crises preclude attention for children with CHD. Patients who have sought care at FLL face other difficulties, including lack of long-term commitment from foreign partners, short-term trips directed at treating "easier" cases, and logistics of continued care. While sustaining a cardiac surgical program locally in LMICs may be a worthy goal, overcoming the myriad of barriers including funding and training professionals is no easy feat. Efforts should focus on creating surgical programs that can triage patients to address RACHS-1 categories 1, 2, and 3 and centralizing programs in LMICs with referral networks (as noted in this study) to address the more complex RACHS-1 categories 4, 5, and 6.","abstract_has_math":false,"creators":["Kim, Stephany"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Murala, John S.","Chang, Mary","Pezzella, A. Thomas"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-06-03T19:52:53Z","date_published":"2025-06-03T19:52:53Z","updated_at":"2026-07-24T05:52:08Z","subjects":["Developing Countries","Heart Defects, Congenital","Quality Improvement","Thoracic Surgery","Cardiac Surgical Procedures"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["1522122361"],"render_values":[{"text":"1522122361","href":null,"code":true}]}]},"links":{"outbound_url":"https://hdl.handle.net/2152.5/10613","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Murala, John S.","Chang, Mary","Pezzella, A. Thomas"]},{"key":"dc:creator","label":"Author","values":["Kim, Stephany"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2025-06-03T19:52:53Z","2023-05","May 2023"]},{"key":"dc:type","label":"Dc Type","values":["Thesis","text"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Developing Countries","Heart Defects, Congenital","Quality Improvement","Thoracic Surgery","Cardiac Surgical Procedures"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://hdl.handle.net/2152.5/10613","1522122361"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["OBJECTIVE: The objective of this study is to analyze the demographics of congenital heart disease (CHD) patients from over 50 low- and middle-income countries (LMICs) who received care at Frontier Lifeline Hospital (FLL), a specialty cardiac center in Chennai, India, and identify the barriers and limitations they faced. METHODS: This two-part retrospective study analyzed International Quality Improvement Collaborative (IQIC) data from Boston Children's hospital and FLL data of CHD patients who received cardiac surgery from 2008 to 2020. The first part collected demographic and clinical data. The second part included interviews with organizations and physicians to identify the barriers to cardiac care faced by patients from LMICs. RESULTS: A total of 3002 patients from various LMICs received care at FLL during this period (2008-2020). Of these patients, 2087 (81%) patients received their first cardiac surgery at FLL. Majority of patients came from the following countries: Fiji (201), Uganda (194), Bahrain (185), Sri Lanka (147), and Kenya (126). Of the total, 1801 (60%) patients were 1 to 18 years old, 975 (32%) were infants, 118 (4%) were neonates, and 108 (4%) were adult congenital, with a median age of 5 years. Common procedures included ventricular septal defect closure (787; 26%) and atrial septal defect repair (700; 23%). Of the total patients, 2950 cases were assigned a Risk adjustment for congenital heart surgery (RACHS-1) score, of which RACHS-1 categories 2 (1146; 39%) and 3 (1033; 35%) comprised the majority. CONCLUSIONS: Though healthcare systems in LMICs see and acknowledge the magnitude of patients with CHD, there are many challenges for providing cardiac care locally. Often, other priorities such as communicable diseases, raging wars, and refugee crises preclude attention for children with CHD. Patients who have sought care at FLL face other difficulties, including lack of long-term commitment from foreign partners, short-term trips directed at treating "easier" cases, and logistics of continued care. While sustaining a cardiac surgical program locally in LMICs may be a worthy goal, overcoming the myriad of barriers including funding and training professionals is no easy feat. Efforts should focus on creating surgical programs that can triage patients to address RACHS-1 categories 1, 2, and 3 and centralizing programs in LMICs with referral networks (as noted in this study) to address the more complex RACHS-1 categories 4, 5, and 6."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Single-Center Experience of Providing Congenital Heart Surgery to Low- and Middle-Income Countries"]}]}],"canonical_facts":{"dc:contributor":["Murala, John S.","Chang, Mary","Pezzella, A. Thomas"],"dc:creator":["Kim, Stephany"],"dc:date":["2025-06-03T19:52:53Z","2023-05","May 2023"],"dc:description":["OBJECTIVE: The objective of this study is to analyze the demographics of congenital heart disease (CHD) patients from over 50 low- and middle-income countries (LMICs) who received care at Frontier Lifeline Hospital (FLL), a specialty cardiac center in Chennai, India, and identify the barriers and limitations they faced. METHODS: This two-part retrospective study analyzed International Quality Improvement Collaborative (IQIC) data from Boston Children's hospital and FLL data of CHD patients who received cardiac surgery from 2008 to 2020. The first part collected demographic and clinical data. The second part included interviews with organizations and physicians to identify the barriers to cardiac care faced by patients from LMICs. RESULTS: A total of 3002 patients from various LMICs received care at FLL during this period (2008-2020). Of these patients, 2087 (81%) patients received their first cardiac surgery at FLL. Majority of patients came from the following countries: Fiji (201), Uganda (194), Bahrain (185), Sri Lanka (147), and Kenya (126). Of the total, 1801 (60%) patients were 1 to 18 years old, 975 (32%) were infants, 118 (4%) were neonates, and 108 (4%) were adult congenital, with a median age of 5 years. Common procedures included ventricular septal defect closure (787; 26%) and atrial septal defect repair (700; 23%). Of the total patients, 2950 cases were assigned a Risk adjustment for congenital heart surgery (RACHS-1) score, of which RACHS-1 categories 2 (1146; 39%) and 3 (1033; 35%) comprised the majority. CONCLUSIONS: Though healthcare systems in LMICs see and acknowledge the magnitude of patients with CHD, there are many challenges for providing cardiac care locally. Often, other priorities such as communicable diseases, raging wars, and refugee crises preclude attention for children with CHD. Patients who have sought care at FLL face other difficulties, including lack of long-term commitment from foreign partners, short-term trips directed at treating "easier" cases, and logistics of continued care. While sustaining a cardiac surgical program locally in LMICs may be a worthy goal, overcoming the myriad of barriers including funding and training professionals is no easy feat. Efforts should focus on creating surgical programs that can triage patients to address RACHS-1 categories 1, 2, and 3 and centralizing programs in LMICs with referral networks (as noted in this study) to address the more complex RACHS-1 categories 4, 5, and 6."],"dc:format":["application/pdf"],"dc:identifier":["https://hdl.handle.net/2152.5/10613","1522122361"],"dc:language":["en"],"dc:subject":["Developing Countries","Heart Defects, Congenital","Quality Improvement","Thoracic Surgery","Cardiac Surgical Procedures"],"dc:title":["Single-Center Experience of Providing Congenital Heart Surgery to Low- and Middle-Income Countries"],"dc:type":["Thesis","text"]},"updated_at":"2026-07-24T05:52:08Z"}