General thoracic surgery as a subspecialty in Colombia

Cardiothoracic surgery training in Africa: History and developments

Objective

Cardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects.

Method

Through a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa.

Results

African countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries.

Conclusions

Cardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.

Twenty-Five Years of Lung Transplantation in Medellín: Overcoming the Challenges of an Emerging Country

The first successful lung transplant in Colombia was performed on October 28, 1997 in Medellín by Alberto Villegas Hernández at the "Clínica Cardiovascular Santa María" today called the Cardio VID Clinic. Here we present both survival outcomes and characteristics of the oldest and most experienced lung transplant program in Colombia. We conducted a retrospective study of all patients taken to lung transplantation at the Cardio VID Clinic in Medellín, Colombia from October 1997 to October 2022. Patient information from our institutional database and transplant archives were retrieved and reviewed. From October 1997 to October 2022, a total of 153 patients underwent orthotopic lung transplantation at our institution in Medellín, Colombia. Mean recipient age was 48 ± 13 years, the youngest patient was 15 years old and the oldest patient was 73 years old at the time of transplant. Seventy-four (48.4%) patients were men and seventy-nine (51.6%) were women. Uncensored lung transplant survival in Medellin at 1 month, 1 year, 5 years, and 10 years were 68%, 50%, 31%, and 12%, respectively. Although health care coverage in Colombia reaches nearly 100%, socioeconomic hurdles during post-transplant care, nonreturning patients, infections, and traumatic donor deaths lead to high mortality rates. Due to these factors, establishing successful and sustainable lung transplant programs in these settings is challenging.

Cardiovascular Surgery in Panama: Evolution and Training

Cardiovascular surgery in Panama has depended on constant contributions and support from other developed countries. Although cardiac surgery has reached important milestones, cardiac surgery training is still evolving. Here, we provide a look into both the development and training of cardiac surgery in the Republic of Panama and the importance of international training.

Miniature Minimally Invasive Pulmonary Banding in Neonates (MINI-MICS): A Novel Technique

Single-ventricular cardiopathies are challenging conditions requiring multiple surgical interventions to hopefully achieve adulthood. In neonates, pulmonary artery banding allows ventricular adaptation and pulmonary vascular bed protection. Here we present a novel minimally invasive approach to pulmonary artery banding through a 1.5 cm left parasternal minithoracotomy. This technique not only allows for a less traumatic first procedure but also a less manipulated mediastinum and untouched sternum for the consequent surgeries to come. This technique is reproducible in experienced hands and shows favorable and promising results when performed properly.

Robotic Cardiac Surgery in Colombia: Overcoming the Challenges of a Middle-income Setting

In developing countries, limited resources and low health budgets result in slow developments in the field of cardiac surgery. As a consequence, advances in surgery become a challenging process. In Colombia, most institutions do not have the capacity or infrastructure for minimally invasive and video-assisted cardiac surgery, let alone robotic assisted cardiac surgery (RACS). Despite the challenges, efforts to overcome these hurdles are critical for the future of cardiac surgery in low-income settings. Here we describe the first cases of robotic cardiac surgeries performed in Colombia.

Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients

Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs).

Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging.

Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively.

Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.

The Women of Colombian Thoracic and Cardiac Surgery: A Survey-based Assessment

In Colombia, the number of younger female surgeons is increasing along with a growing interest in thoracic and cardiac surgery. It is our duty to motivate young female surgeons in pursuing a career in chest surgery to answer the already growing deficit of cardio-thoracic surgeons.