The Cape Town declaration on access to cardiac surgery in the developing world; is it a true reflection of the needs of SSA?

• Published in: SA heart journal Vol. 16; no. 4; p. 301
• Main Authors: Reddy, Darshan, Yankah, Charles, Kinsley, Robin H.
• Format: Journal Article
• Language: English
• Published: The South African Heart Association 01.12.2019
• ISSN: 1996-6741; 2071-4602; 2071-4602
• DOI: 10.24170/16-4-3839

We read with interest the article by Zille, et al. entitled the Cape Town Declaration on access to cardiac surgery in the developing world.(1) The declaration never mentions the burden of congenital heart disease in Africa. Rather, corrective “lifesaving surgery” for rheumatic heart disease (largely valve replacement) is emphasised. Is this an oversight? Expensive valve replacement surgery in Africa is a disaster and should not be advocated. Anticoagulation in low- and middleincome countries is hopelessly inadequate; penicillin prophylaxis is variable. By contrast, mitral valve repair is rarely performed(2) because of fly in missions and lack of skills. Even the results of mitral valve repair for rheumatic valvular disease is suboptimal, and is inferior to the results of repair for degenerative mitral valve disease.