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Global cardiac surgery: Access to cardiac surgical care around the world
Open accessAbstract
Objective Cardiovascular disease is the leading cause of death worldwide, responsible for 17.5 million deaths every year, of which 80% occur in low- and middle-income countries. Some 75% of the world does not have access to cardiac surgery when needed because of lack of infrastructure, human resources, and financial coverage. This study aims to map access to cardiac surgery around the world. Methods A scoping review was done on access to cardiac surgery for an undifferentiated population. Workforce data were collected from the Cardiothoracic Surgery Network database and used to calculate numbers and ratios of adult and pediatric cardiac surgeons to population. Results A total of 12,180 adult cardiac surgeons and 3858 pediatric cardiac surgeons were listed in the Cardiothoracic Surgery Network in August 2017, equaling 1.64 (0-181.82) adult cardiac surgeons and 0.52 (0-25.97) pediatric cardiac surgeons per million population globally. Large disparities existed between regions, ranging from 0.12 adult cardiac surgeons and 0.08 pediatric cardiac surgeons per million population (sub-Saharan Africa) to 11.12 adult cardiac surgeons and 2.08 pediatric cardiac surgeons (North America). Low-income countries possessed 0.04 adult cardiac surgeons and 0.03 pediatric cardiac surgeons per million population, compared with 7.15 adult cardiac surgeons and 1.67 pediatric cardiac surgeons in high-income countries. Conclusions This study maps the current global state of access to cardiac surgery. Disparities exist between and within world regions, with a positive correlation between a nation's economic status and access to cardiac surgery. Low early mortality rates in low-resource settings suggest the possibility of high-quality cardiac surgery in low- and middle-income countries. There is the need to increase human and physical resources, while focusing on safety, quality, and efficiency to improve access to cardiac surgery for the 4.5 billion people without.
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“As a result, there are approximately 2.5 million people in need of cardiac surgery in low-income countries.14”
From Tetralogy of Fallot in Low- and Middle-Income Countries (2024) · cites this paper as [14]
In the citing paper
“Globally, a recent study using the Cardiothoracic Surgery Network data estimated that many countries, particularly in Africa, do not have a paediatric cardiac surgery centre despite that their populations sometimes exceed 70 million.14”
From Tetralogy of Fallot in Low- and Middle-Income Countries (2024) · cites this paper as [14]
In the citing paper
“There are also major disparities in the distribution of congenital heart surgeons, with a rate of 0.08 surgeons per million vs 2.08 surgeons per million inhabitants in sub-Saharan Africa and in North America, respectively (Fig. 1).”
From Tetralogy of Fallot in Low- and Middle-Income Countries (2024) · cites this paper as [14]
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“11,16 With most cardiothoracic surgeons concentrated outside the borders of Africa, more than 42 % in North America and 32 % in Europe, Africa has approximately 1 % cardiothoracic surgeons at its disposal.”
BackgroundInsights into the Molecular Mechanism of Endothelial Glycocalyx Dysfunction during Heart Surgery
Kršek, A., Batičić, L., Ćurko‐Cofek, B., Batinac, T., Laškarin, G., Gršković, S. M., & Tokmadžić, V. S. (2024) · Current Issues in Molecular Biology · doi:10.3390/cimb46050236 · Cited by 13
“Every year, about a million cardiac treatments are performed worldwide [55].”
BackgroundAvancini, L., Silva, L. D. A., da Silva, V. R., & Duarte, C. K. (2022) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2022.03.003 · Cited by 13
Tetralogy of Fallot in Low- and Middle-Income Countries
Dib, N., Chauvette, V., Diop, M. S., Bouhout, I., Hadid, M., Vô, C., Khairy, P., & Poirier, N. (2024) · CJC Pediatric and Congenital Heart Disease · doi:10.1016/j.cjcpc.2023.12.002 · Cited by 19
Rao, R. A., Varghese, S. S., Ansari, F., Rao, A., Meng, E., & El-Diasty, M. M. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.09.101 · Cited by 12
Su, Z., Li, X., Liu, Z., Wu, H., Li, S., Chen, H., & Zhang, H. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.555141 · Cited by 12
National trend in failure to rescue after cardiac surgeries
Alabbadi, S., Roach, A., Chikwe, J., & Egorova, N. (2022) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2022.02.037 · Cited by 12
Vervoort, D., & Velazco-Davila, L. D. (2020) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2020.03.143 · Cited by 12
Self-citationBuilding cardiac surgical programs in lower-middle income countries
Dindi, K., Cain, M. T., Odera, A., Joyce, D. L., Joyce, L. D., Leta, A. F., & White, R. E. (2023) · JTCVS Open · doi:10.1016/j.xjon.2023.01.009 · Cited by 11
Management of Congenital Heart Disease in Low-Income Countries: The Challenges and the Way Forward
Elshazali, O. H., Ibrahim, M., & Elseed, A. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.104830 · Cited by 11
Massoth, C., Küllmar, M., Moncho, A. P., González-Suárez, S., Grigoryev, E. V., Александрович, И. А., von Dossow, V., Ott, S., Rau, N., Meersch, M., et al. (2023) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001837 · Cited by 11
Access to paediatric cardiac surgery in Colombia: a population-based study
Sabatino, M. E., Dennis, R., Sandoval-Trujillo, P., Valencia, S. A., Moreno, K., Londoño, D., García-Torres, A. E., Tulloch, D. L., Herrera‐Almario, G., Peck, G., et al. (2021) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezab404 · Cited by 11
Sex Differences in Opioid Administration After Cardiac Surgery
Karamesinis, A. D., Neto, A. S., Shi, J., Fletcher, C. M., Hinton, J. V., Xing, Z., Penny‐Dimri, J. C., Ramson, D. M., Liu, Z., Plummer, M. P., et al. (2023) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2023.11.044 · Cited by 10
Guntaka, P. K., Harris, J. A., Niedziela, C. J., Bass, M. B., & Afshar, S. (2022) · International Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.ijom.2022.04.006 · Cited by 10
Healthcare disparities in pediatric neurosurgery: a scoping review
Maddy, K. S., Eliahu, K., Bryant, J.-P., García, R. M., Du, R. Y., Lam, S. K., & Niazi, T. N. (2023) · Journal of Neurosurgery Pediatrics · doi:10.3171/2023.3.peds2363 · Cited by 10
Cardiac Surgery Air-Bridging in the Caribbean
Vinck, E. E., & Vervoort, D. (2020) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.1053/j.semtcvs.2020.05.002 · Cited by 10
Self-citationHan, S., Choi, S., Park, J., Kweon, S., Oh, S. J., Shakya, H. B., Heo, J., & Kim, W. (2022) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3463 · Cited by 9
Editorial Board Composition Among Pediatric Cardiology Journals
Dunne, E., Zuhlke, L. J., Kumar, R., Casey, F. A., Penny, D. J., & McMahon, C. J. (2022) · JACC Advances · doi:10.1016/j.jacadv.2022.100137 · Cited by 10
Bekele, A., Alayande, B. T., Gulilat, D., White, R. E., Tefera, G., & Borgstein, E. S. (2024) · World Journal of Surgery · doi:10.1002/wjs.12278 · Cited by 9
A New Benchmark for Modern Management of Valvular Heart Disease
Wang, Y., Cao, T., Liu, X., He, S., Ran, Z., Du, C., Lu, B., Liu, Y., Shi, J., Liu, L., et al. (2025) · JACC Asia · doi:10.1016/j.jacasi.2025.01.017 · Cited by 9
Soleimani, H., Bahiraie, P., Tavakoli, K., Mohammadi, N. S. H., Hajari, P., Taheri, H., Hosseini, K., & Ebrahimi, P. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.037291 · Cited by 9
Tian, C., Zhang, X., Tang, H., Luo, N., Huang, J., Lin, H., Yang, Q., Chen, Y., & Tan, X. (2025) · BMC Public Health · doi:10.1186/s12889-025-23067-7 · Cited by 9
“…been reported that the number of adult and pediatric cardiac surgeons in high-income countries are 179 and 136 times greater than in low-income countries (7.5 per million population vs. 0.04 per million population; 9.51 per million population vs. 0.07 per million population), respectively [37, 38].”
InfluentialManuel, V., Miana, L. A., & Edwin, F. (2021) · AME Surgical Journal · doi:10.21037/asj-21-34 · Cited by 9
Perspectives in Training and Professional Practice of Cardiac Surgery in Latin America
Cuartas, M. M., Vervoort, D., Contreras, J. R., Garcı́a-Villarreal, O. A., Escobar, A., Ferrari, J., Quintana, E., Sádaba, R., Mestres, C. A., Carosella, V., et al. (2023) · Brazilian Journal of Cardiovascular Surgery · doi:10.21470/1678-9741-2022-0125 · Cited by 9
“However, LATAM is still underperforming cardiac surgical volumes due to an insufficient workforce[4].”
BackgroundSelf-citationArab, Y., Harahsheh, A. S., Dahdah, N., El-Kholy, N., Abed, M. Y., Saoud, S. A. A., Agha, H. M., Alahmadi, F., Amer, S. R. A., Awadhi, Z. A., et al. (2023) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/21501351231205570 · Cited by 9
“27 In North African Arab countries, the use of PCI differs signi fi cantly between countries; only 2.5% of ST-segment elevation myocardial infarction (STEMI). are managed by early PCI in Algeria compared with 22% in both Morocco and Tunisia.”
ResultInfluentialRheumatic Heart Disease Burden
Milutinovic, S., Petrovic, M. T., Ziq, A., Sanchez, C., Hammami, A. S., Escarcega, R. O., Begosh-Mayne, D., Wood, M. J., Chazal, R. A., & Lopez‐Mattei, J. (2024) · JACC Advances · doi:10.1016/j.jacadv.2024.101393 · Cited by 8
Otolaryngology–Head and Neck Surgery Training and Service Delivery: An International Survey
Nuss, S. R., Nakku, D., Pandey, A., Elwell, Z., Fei‐Zhang, D. J., Srinivasan, T., Patterson, R. H., Adeyemo, A. A., Cherches, A., Bangash, A. H., et al. (2025) · Laryngoscope Investigative Otolaryngology · doi:10.1002/lio2.70096 · Cited by 8
“Our findings are supported by existing studies that describe the inequitable distribution of healthcare resources and opportunities within surgical care globally [2, 16, 17].”
Mesfin, S., Hiwot, T., Aliye, N. J., Yimam, E., & Awad, A. K. (2025) · BMC Surgery · doi:10.1186/s12893-025-02928-3 · Cited by 8
“The high cost of cardiothoracic surgery, combined with a reliance on out-of-pocket payments and limited insurance coverage for procedures like open-heart surgery in Africa, restricts access to care for many individuals [16].”
InfluentialBetween Air and Artery: A History of Cardiopulmonary Bypass and the Rise of Modern Cardiac Surgery
Leivaditis, V., Maniatopoulos, A. A., Mulita, F., Katsakiori, P. F., Baikoussis, N. G., Mitsos, S., Liolis, E., Garantzioti, V., Tasios, K., Leventis, P., et al. (2025) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd12090365 · Cited by 8
“…environments continue to use antiquated or refurbished CPB machines, resulting to life-saving treatments such as open heart surgery or ECMO for respiratory failure being either inaccessible or limited to a small population, frequently in urban academic hospitals or private institutions [169,170].”
Sarmadi, S., Sanaie, N., & Zare‐Kaseb, A. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2576638 · Cited by 8
“Cardiovascular Diseases (CVDs) are among the most common diseases worldwide [1].”
Zhang, D., Gu, D., Rao, C., Zhang, H., Su, X., Chen, S., Ma, H., Zhao, Y., Feng, W., Sun, H., et al. (2022) · BMJ Quality & Safety · doi:10.1136/bmjqs-2021-014244 · Cited by 9
Hagerman, A., Schorer, R., Putzu, A., Barcelos, G. K., & Licker, M. J. (2022) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.1053/j.semtcvs.2022.11.002 · Cited by 8
“916) Ventricular Fibrillation 11 (1,758) 210/903 159/855 OR=0.”
InfluentialTiwari, K. K., Grapsa, J., Laudari, S., Pazderník, M., & Vervoort, D. (2020) · Perfusion · doi:10.1177/0267659120924923 · Cited by 8
Self-citationDelivering pediatric cardiac care in sub-Saharan Africa: a model for the developing countries
Ansong, A. K., Yao, N.-A., Fynn‐Thompson, F., & Edwin, F. (2020) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000801 · Cited by 8
“[6] ‘highlighted the dearth in pediatric cardiac specialists in the region as there is more than 58 times the number of pediatric cardiac surgeons in North America than in SSA.”
BackgroundMinimally Invasive Thoracic Surgery for Low- and Middle-Income Countries
Lin, Y., Vervoort, D., Thapa, B., Sapkota, R., & Mitchell, J. D. (2022) · Thoracic surgery clinics/Thorac. surg. clin. · doi:10.1016/j.thorsurg.2022.04.003 · Cited by 7
Self-citationEnhancing early functional independence following cardiac surgery: a quality improvement programme
Jacob, P., Surendran, P. J., Gupta, P., Mahinay, M., Sarmiento, A. L., Abas, A., Mohammed, S. A., Sarhan, H. H. T., Ureta, J., Mathew, G., et al. (2023) · BMJ Open Quality · doi:10.1136/bmjoq-2022-002190 · Cited by 7
A Landscape Analysis of Pediatric and Congenital Heart Disease Services in Africa
Aldersley, T., Ali, S., Dawood, A., Edwin, F., Jenkins, K. J., Joachim, A., Lawrenson, J., Reddy, D., Boumzebra, D., Louis, J. D. S., et al. (2025) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/21501351251316230 · Cited by 7
Predicting the Need for Cardiovascular Surgery: A Comparative Study of Machine Learning Models
Ghavidel, A., Pazos, P., Suarez, R. D. A., & Atashi, A. (2024) · Journal of Electronics Electromedical Engineering and Medical Informatics · doi:10.35882/jeeemi.v6i2.359 · Cited by 7
“Effective use of machine learning can lead to more efficient surgical planning, fewer complications, and better patient outcomes, thereby reducing the financial burden of cardiovascular surgeries [6-8].”
BackgroundDegenerative Mitral Regurgitation Outcomes in Asian Compared With European-American Institutions
Hamid, N. B., Bursi, F., Benfari, G., Vanoverschelde, J., Tribouilloy, C. M., Biagini, E., Aviérinos, J.-F., Barbieri, A., Fan, Y., Guerra, F., et al. (2024) · JACC Asia · doi:10.1016/j.jacasi.2024.03.003 · Cited by 7
Cardiac surgery in West Africa: the tipping point
Vervoort, D., & Kpodonu, J. (2020) · Cardiology in the Young · doi:10.1017/s104795111900310x · Cited by 7
Self-citationKang, H. S., Robertson, E., Vohra, H., Richter, W., Lanning, D. A., & DeAntonio, J. H. (2022) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2021.12.057 · Cited by 7
Wittenberg, R. E., Gauvreau, K., Desocio, M. B., Du, X., Jayasankar, J. P., Sandoval, N. F., & Jenkins, K. J. (2024) · JACC Advances · doi:10.1016/j.jacadv.2024.101332 · Cited by 6
Global Cardiac Surgery and the Global Burden of Disease
Vervoort, D., & Pezzella, A. T. (2021) · Sustainable development goals series · doi:10.1007/978-3-030-83864-5_8 · Cited by 6
Self-citationLin, H., Hou, J., Gong, J., Wu, Y., & Zheng, Z. (2022) · BMC Cardiovascular Disorders · doi:10.1186/s12872-022-02612-x · Cited by 6
“Moreover, the availability of adult and pediatric cardiac surgical workforces is scarce in lowand middle-income countries [21].”
Background
Metadata
- Authors
- Vervoort, D., Meuris, B., Meyns, B., & Verbrugghe, P.
- Affiliations
- Harvard University (US)
- Universitair Ziekenhuis Leuven (BE)
- Corresponding author
- Vervoort, Dominique
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 159
- Issue
- 3
- Pages
- 987-996.e6
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2940834286
- Cited by
- 287
- References
- 45
- Citations by year
- 2026: 39 · 2025: 49 · 2024: 55 · 2023: 46 · 2022: 38 · 2021: 33 · 2020: 22
- FWCI
- 3.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Health Sciences › Medicine › Surgery › History of Medical Practice
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- access to cardiac surgery, cardiac surgeons, pediatric cardiac surgery, low- and middle-income countries, global health disparities, cardiovascular mortality, surgical workforce, regional disparities, sub-Saharan Africa
- MeSH terms
- Developing Countries, Health Services Accessibility, Health Services Needs and Demand, Cardiac Surgical Procedures, Humans, Specialization, Global Health, Health Care Costs, Quality Indicators, Health Care, Needs Assessment, Healthcare Disparities, Surgeons
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