Developing a cardiac surgery unit in the Caribbean: A reflection

Gianni D Angelini*, Richard Ramsingh, Natasha Rahaman-Ganga, Risshi Rampersad, Anand Rampersad, Kamal Rampersad, Giovanni Teodori

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Background and Aim
Access to specialized cardiac surgery is a problem in emerging countries. Here, we reflect on the approach we used to establish a cardiac surgery unit in Trinidad and Tobago.

The program started in 1993 with monthly visits by a team from Bristol Heart Institute. A group of local doctors, nurses, and perfusionists were identified for training, and a senior nurse moved to the island to start a teaching program. The visiting support was gradually reduced, and the local team gained independence in managing the service in 2006.

The initial low volume surgery increased to around 380 cases a year with the implementation of comprehensive service in 2006. Most patients required coronary artery bypass graft (CABG). In‐hospital mortality declined from 5% in the nascent years to below 2% thereafter. In the last 5 years (2015‐2019), 1764 patients underwent surgery (mean age 59.6 ± 10.8 years, 66% male). The majority were East‐Indian‐Caribbean (79.1%) or Afro‐Caribbean (16.7%), half had diabetes, and two‐thirds hypertension (EuroScore II 1.8 ± 1.9). The majority (1363 patients) underwent CABG (99.5% off‐pump; conversion to on‐pump 1.5%). The mean number of grafts was 2.5 ± 0.7 with 98.5% and 23.1% receiving one and two or more arterial grafts, respectively. In‐hospital mortality was 1.1%, re‐exploration for bleeding 2%, stroke 0.1%, mediastinitis 0.2%. The length of the postoperative hospital stay was 5.8 ± 2 days.

Frequent outside visits complemented by training in an overseas center, and transfer of knowledge proved to be an effective strategy to develop a cardiac surgery unit in an emerging country with results comparable to accepted international standards.
Original languageEnglish
Number of pages8
JournalJournal of Cardiac Surgery
Early online date21 Aug 2020
Publication statusE-pub ahead of print - 21 Aug 2020

Structured keywords

  • Bristol Heart Institute


  • cardiac surgery
  • emerging country
  • English‐speaking Caribbean
  • global health
  • Trinidad and Tobago

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