An international partnership model for pediatric congenital heart surgery in three Latin American countries achieved an overall mortality of 1.05% compared to a predicted mortality of 3.8%.
Does an international partnership model for congenital heart surgery improve observed versus expected mortality in pediatric patients in resource-constrained settings?
Congenital heart surgery performed through international partnerships in resource-constrained settings can achieve mortality rates significantly lower than predicted and comparable to high-income country benchmarks.
Absolute Event Rate: 0% vs 0%
Introduction: Congenital heart disease (CHD) is a leading cause of pediatric morbidity and mortality globally, with disproportionate burden in low- and middle-income countries (LMICs). Although surgical mortality in high-income countries (HICs) has dropped below 3%, data from LMICs remain limited. This study evaluates outcomes of congenital heart surgeries performed through an international partnership model in Latin America, aiming to assess performance relative to global benchmarks. Methods: We conducted a retrospective analysis of 280 pediatric patients who underwent CHD surgery in El Salvador, Mexico, and Peru from 2015 to 2019, as part of Heart Care International’s mission-based program. Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores were retrospectively assigned to stratify procedural complexity. Primary outcomes included observed versus expected mortality and length of hospital stay (LOS). Data were compared across countries and over time. Results: The cohort had a mean age of 5.1 years and mean weight of 17.95 kg. The average RACHS-1 score was 1.67, with increasing complexity observed in later years. Despite a predicted cohort mortality of 3.8%, the overall observed mortality was 1.05%. Mexico demonstrated 100% survival across all years despite the highest average RACHS-1 scores (1.81). Peru and El Salvador also achieved high survival rates (98.6% and 98.3%, respectively). Length of stay remained within global standards (mean: 4.09 days), and higher-complexity procedures were associated with longer LOS. Conclusions: This study demonstrates that high-quality CHD surgical outcomes are achievable in LMICs through sustained, capacity-building global partnerships. Observed mortality rates were significantly lower than expected and comparable to HIC benchmarks, even for moderately complex procedures. These findings support the expansion of equitable, long-term collaborations that prioritize local expertise, infrastructure investment, and perioperative system strengthening to sustainably improve pediatric cardiac outcomes in resource-limited settings.
Bidwell et al. (Sun,) reported a other. An international partnership model for pediatric congenital heart surgery in three Latin American countries achieved an overall mortality of 1.05% compared to a predicted mortality of 3.8%.
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