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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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“Despite the fact that approximately 1.5 million cardiac surgeries are performed globally each year [34], making it a leading reason for ICU admissions [13, 35], more detailed exploration of these specific ICU experiences is needed.”
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“Facilities of thoracic surgery are not widely available in developing countries, [18,19] which face the highest burden of tuberculosis.”
BackgroundMohmmedahmed, M. A., Eltahir, E. M., Mohammedali, A. M., & Yousef, B. A. (2023) · Clinical Case Reports · doi:10.1002/ccr3.7901 · Cited by 2
Solikhah, T. I., & Solikhah, G. P. (2023) · Research Journal of Pharmacy and Technology · doi:10.52711/0974-360x.2023.00785 · Cited by 2
Redefining global cardiac surgery through an intersectionality lens
Vervoort, D., Elfaki, L. A., Servito, M., Herrera-Morales, K. Y., & Kanyepi, K. (2023) · Medical Humanities · doi:10.1136/medhum-2023-012801 · Cited by 2
“Applying a biomedical lens, six billion people are estimated to lack access to safe, timely and affordable cardiac surgical care when needed (Vervoort et al .”
BackgroundSelf-citationAssessment of the financial gaps in cardiothoracic surgery in Africa
Nwalibe, C., Effiom, V. B., Anyinkeng, A. B.-S., James, M., Genda, E.-E., Irungu, W., Abaiweh, F.-A., & Okonta, K. E. (2024) · Interdisciplinary CardioVascular and Thoracic Surgery · doi:10.1093/icvts/ivae228 · Cited by 2
Sarma, P. S., Mogane, P., Vanderdonck, K. M., Kebalepile, M. M., & Chakane, P. M. (2025) · Congenital Heart Disease · doi:10.32604/chd.2025.060382 · Cited by 2
“These reported advances in care are still not available for over 90% of children born with CHD in low-and middle-income countries (LMIC) [6].”
Beyond 2025: Projections of cardiothoracic surgeon demographics in France
Saiydoun, G., Saadé, S., Aludaat, C., Leprince, P. N., Fadel, G., Verhoye, J., Vincentelli, A., Thomas, P. A., Armand, E., Lebreton, G., et al. (2025) · Archives of cardiovascular diseases · doi:10.1016/j.acvd.2025.04.057 · Cited by 2
Endovascular Treatment for Aortic Diseases: Intercontinental Disparities
Naik, G., Wadiwala, I. J., & Hiremath, N. (2025) · Current Cardiology Reports · doi:10.1007/s11886-025-02260-5 · Cited by 2
“Fewer than 1,000 EVAR/TEVARs are performed continent-wide, with 200 [88] aortic-trained surgeons—mostly cardiac specialists [45].”
Saputra, P. B. T., Widiarti, W., Siahaan, P. P., Putra, R. M., Kriswidyatomo, P., Faizah, N. N., & Alkaff, F. F. (2025) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2025.08.026 · Cited by 2
Kasputytė, G., Putnynaite, V., Chaleckas, E., Bartušis, L., Hamarat, Y., Žakelis, R., Švagždienė, M., Kumpaitienė, B., Andrejaitienė, J., Lenkutis, T., et al. (2025) · Minerva Anestesiologica · doi:10.23736/s0375-9393.25.18890-1 · Cited by 2
Ten years of pediatric congenital heart disease surgery in a Caribbean nation
Pradegan, N., Leon, J. R., Muñoz, Y. M., Toribio, J., Pérez, R., Elías, W., Vargas, F., & Herrera, C. J. (2022) · International Journal of Cardiology Congenital Heart Disease · doi:10.1016/j.ijcchd.2022.100329 · Cited by 2
Evaluating the World Heart Federation’s 25 by 25: The Forgotten Millions
Vervoort, D. (2019) · Global Heart · doi:10.1016/j.gheart.2019.08.004 · Cited by 2
“15 per million population in high-income countries [3].”
BackgroundSelf-citationRole of Cardiothoracic Surgery Societies in Global Health Disparities
Godoy, L. A., Cooke, D. T., & Young, J. N. (2021) · Sustainable development goals series · doi:10.1007/978-3-030-83864-5_17 · Cited by 2
Kelly, T., & Hurst, A. R. (2022) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2022.10.043 · Cited by 2
Dell’Aiera, L., Fitzgerald, D. C., Fisher, D. E., & Gill, N. W. (2023) · Journal of ExtraCorporeal Technology · doi:10.1051/ject/2023044 · Cited by 2
“The challenges to healthcare access are multifactorial but one contributor is a lack of trained personnel [2].”
BackgroundAzap, L. E., Díaz, A., Gouchoe, D. A., Mokadam, N. A., Smith, S. A., Henn, M. C., Whitson, B. A., Habib, A., Lampert, B. C., Pawlik, T. M., et al. (2024) · JHLT Open · doi:10.1016/j.jhlto.2024.100079 · Cited by 2
Tadege, M., Tegegne, A. S., & Dessie, Z. G. (2024) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-024-02480-9 · Cited by 2
“However, about 6 billion people worldwide, primarily in low-and middle-income countries, lack access to cardiac surgery [5].”
BackgroundThe Global Cardiothoracic Surgery Workforce in 2020
Cardarelli, M. G. (2021) · Sustainable development goals series · doi:10.1007/978-3-030-83864-5_12 · Cited by 2
The elephant in the room: Social media as a tool
Vervoort, D. (2019) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2019.09.068 · Cited by 2
Self-citationGlobal Cardiac Surgery in Brazil: A Call to Action
Faleiro, M. D., Fernandez, M. G., Feitosa, K. I. B., & Vervoort, D. (2024) · Brazilian Journal of Cardiovascular Surgery · doi:10.21470/1678-9741-2023-0408 · Cited by 1
“Zilla et al. (2018) [4] estimated that Brazil has 10.4 cardiac surgeons per million people, higher than the average of high-income countries (HICs) [5] , but raised concerns regarding the heterogeneity in the availability of cardiac surgery services within the Brazilian territory, with the South…”
BackgroundInfluentialSelf-citationMehta, S., Puskas, J., Sethi, Y., Reddy, M. M., & Yadava, O. (2024) · Journal of Vascular Diseases · doi:10.3390/jvd3040037 · Cited by 1
“Significant differences in the availability of cardiac surgery assets are noted around the world, with a better doctor-patient ratio in high-income countries [52].”
Druckman, S. I., Moss, J. P., Chaves, A. H., Gaskin, P. R. A., Scala, M. L., Linehan, D., Tumulty, J. A., Pietris, N., Nicolosi, C., Eichner, J. R., et al. (2025) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/21501351251322157 · Cited by 1
Mendes, V., Mouloudi, A., Jolou, J., Nałęcz, T., Abecasis, A. B., Pereira, T. S., & Sologashvili, T. (2025) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-025-03475-x · Cited by 1
“Programs enabling echocardiographic screening and technical training in humanitarian contexts are essential for ensuring more equitable and effective practices [22].”
Emphasizing the role of cardiothoracic surgeons within the global health context: a call to action
Anyinkeng, A. B.-S., Alassiri, A. K., Ibekwe, J. L., Nchonganyi, E. J. P., Fodop, S. G. J., Effiom, V. B., & Okonta, K. E. (2025) · Annals of Medicine and Surgery · doi:10.1097/ms9.0000000000003678 · Cited by 1
“Globally, 1.64 and 0.52 cardiac surgeons exist per million adult and pediatric populations respectively while the number drops to 0.04 per million adult population in low-income countries [ 13 ] .”
InfluentialWomen in Cardiothoracic Surgery in France: Current Status and Workforce Projections to 2040
Armand, E., Bernard, C., Giraud, J., Boutet, A., Saadé, S., & Saiydoun, G. (2025) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezaf313 · Cited by 1
Kandavello, G. (2025) · Journal of Asian Pacific Society of Cardiology · doi:10.15420/japsc.2025.27 · Cited by 1
Mohmmedahmed, M. A., Abdellah, A., Yousef, B. A., Saeed, M. Y., Eltahir, E. M., Ahmed, N., Hassan, M. A. E., Taha, H., Salahaldeen, O., Elmahi, M., et al. (2025) · BMC Pediatrics · doi:10.1186/s12887-025-06245-9 · Cited by 1
“Pediatric cardiac surgery remains inaccessible across low-income countries (LICs), demanding advance infrastructure, specialist expertise, and sustained investment [1, 2].”
Sivalingam, S., Kottayil, B. P., & Jonas, R. A. (2025) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-025-02101-8 · Cited by 1
Female cardiothoracic surgeons are grossly underrepresented even today
Vosloo, S. M. (2025) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-025-02149-6 · Cited by 1
“The number of paediatric cardiac surgeons in HICs in 2020 was 9.505/million children, and in low-income countries it was 0.071/million children, with sub-Saharan Africa at only 0.19 paediatric cardiac surgeons/million children [59].”
InfluentialMazzoli‐Rocha, F., Stein, R., Steinmetz, C., Sadlonova, M., Borghi‐Silva, A., & Schmidt, T. (2025) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20250377 · Cited by 2
Care pathways for pediatric surgical conditions
Vuddemarry, M., Zadey, S., Sp, A., Ghosh, D., & Zheleva, B. (2026) · World Journal of Pediatric Surgery · doi:10.1136/wjps-2025-001126 · Cited by 1
Mazzoli‐Rocha, F., Stein, R., Steinmetz, C., Sadlonova, M., Borghi‐Silva, A., & Schmidt, T. (2025) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20250377i · Cited by 1
“Despite over four decades of research supporting the benefits of prehabilitation, 2 — including its recommendation in international guidelines for patients undergoing elective cardiac surgery 5,6,16 — prehabilitation has yet to be recognized as a valuable intervention opportunity in Brazilian…”
González, S. M., Bernal, S. C., Echavarría, M. E., Hernández, S. S., Zapata, J. A. S., Uribe, A. E., & Jiménez, R. J. M. (2026) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-026-03879-3 · Cited by 1
“This highlights a critical ‘real-world’ barrier in global cardiac surgery: the adoption of MIM-VS in emerging economies is often limited not by surgical skill, but by the availability of essential technologies [25].”
Cardiac Surgery in Chile: Preoperative risk characterization and analytical outcomes
Enrique Seguel, S., Castillo, B., & Guínez-Molinos, S. (2026) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-026-03895-3 · Cited by 1
Dexheimer, L., Freitas, J. L., Pessôa, F. D. D. L., Veronese, E. T., Brandão, C. M. D. A., Sampaio, R. O., Spina, G. S., & Tarasoutchi, F. (2026) · Global Heart · doi:10.5334/gh.1581 · Cited by 1
Surgical excellence—an ongoing quest
Nair, S. K. (2020) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-020-00979-0 · Cited by 1
Developing a cardiac surgery unit in the Caribbean: A reflection
Angelini, G. D., Ramsingh, R. A. E., Rahaman, N. C., Rampersad, R. D., Rampersad, A., Rampersad, K. A., & Teodori, G. (2020) · Journal of Cardiac Surgery · doi:10.1111/jocs.14965 · Cited by 1
“They suggested a unified approach that includes these organizations, perhaps with an overarching, more global administrative structure, that could allocate needed resources to specific areas.(6) However, what seems to be missing, as suggested by Ferraris and Pezzella,(7) is an organized approach that understands the n…”
BackgroundBio-engineering Considerations for Prosthetic Heart Valves
Wang, S. X., Vervoort, D., Roche, E. T., & Kpodonu, J. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-822944-6.00063-3 · Cited by 1
Self-citationPerfil cirúrgico e taxa de extubação precoce em pacientes no pós-operatório de cirurgia cardíaca
dos Santos, R. P., & de Sena, E. P. (2023) · Revista de Ciências Médicas e Biológicas · doi:10.9771/cmbio.v22i3.57637 · Cited by 1
da Silva, N. C. C., Almeida, G. L., Pimenta, H. O. D. S., Guimarães, A. R., & Cordeiro, A. L. L. (2024) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2024.01.007 · Cited by 1
Hamad, A. K., Chachar, T. S., Alhashli, A. J., Ikram, B., Yousif, K. A., Suwaidi, M. A., Tareif, H., Arekat, Z., & Khalifa, A. A. (2024) · International Journal of Recent Surgical and Medical Sciences · doi:10.25259/ijrsms_30_2023 · Cited by 1
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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