Zambia, which also suffers from a scarcity of healthcare personnel, with fewer than 10 cardiac specialists in both the government and private sector for its population of around 20m people, has completed its first total aortic arch replacement
In September 2021, its first National Heart Hospital began performing cardiac surgeries, and recently, its surgeons completed Zambia’s first total aortic arch replacement – guided by a team from University of Michigan Health, USA.
A six-person surgical team travelled from the US to Africa in late February to co-lead this case and several others at the government-established, 120-bed facility in Lusaka.
The historic procedure to replace the ascending aorta and aortic arch of a 72-year-old patient took place on 2 March. The patient’s echocardiogram revealed a potentially fatal aortic dissection that reached 8cm in diameter and extended into both his carotid arteries.
The surgery, which lasted six hours, was uneventful with no complications, reports Michigan Medicine.
“It was a tremendous privilege to work with the providers at National Heart Hospital on this historic case,” said Gorav Ailawadi, MD, director of the University of Michigan Health Frankel Cardiovascular Centre and Helen F and Marvin M Kirsh, Professor and chair of cardiac surgery at U-M Medical School.
The US team worked with MD Chileshe Mutema, chief of cardiothoracic surgery at National Heart Hospital.
In the past, Mutema says, expatriate cardiac surgeons were hired periodically to fly in for procedures, yet less than 1% of patients who needed cardiac surgery saw benefits.
“Performing this case with U-M showed us what is possible and that the capacity to do complex cases comes with a knowledgeable, experienced and well-organised team,” Mutema said.
The team faced several challenges while operating. Beyond the fact that no provider had repaired an aortic arch, supplies were limited in all cases.
When performing operations in the US, surgical teams employ a method called hypothermic circulatory arrest, or HCA; this temporarily cools the body and suspends blood flow while preserving brain function and preventing stroke.
For the aortic arch replacement at National Heart Hospital, surgeons had no access to a multi-branch graft that allows them to employ circulatory arrest only once during a procedure.
Instead, they had to tailor a straight tube graft that forced surgeons to subject the patient to two episodes of hypothermic arrest. The team also devised a way to maintain some blood flow in the brain through a blood vessel.
In another case, during a double valve replacement in a 49-year-old, they ran out of tubing kits used to deliver medications and nutrients that keep the heart from beating during surgery.
This time, the surgical team applied fibrillatory arrest, a challenging method to open the heart while it is still beating, to perform a mitral valve replacement. They also repaired the patient’s tricuspid valve – for which they needed to fashion a tricuspid ring out of a piece of felt.
Michigan Medicine – Guiding-zambian-cardiac-surgical-teams-through-complex-operation