CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
432
AFRICA
Cardiac surgical experience in northern Nigeria
J NWILOH, S EDAIGBINI, S DANBAUCHI, I BABANIYI, M AMINU, Y ADAMU, A OYATI
Abstract
A pilot study was undertaken to determine the feasibility of
establishing a heart surgery programme in northern Nigeria.
During three medical missions by a visiting US team, in part-
nership with local physicians, 18 patients with heart diseases
underwent surgery at two referral hospitals in the region.
Sixteen (88.9%) patients underwent the planned operative
procedure with an observed 30-day mortality of 12.5% (2/16)
and 0% morbidity. Late complications were anticoagulant
related in mechanical heart valve patients and included a
first-trimester abortion one year postoperatively, and a death
at two years from haemorrhage during pregnancy. This has
prompted us to now consider bioprosthetics as the valve of
choice in women of childbearing age in this patient popula-
tion. This preliminary result has further stimulated the inter-
est of all stakeholders on the urgency to establish open-heart
surgery as part of the armamentarium to combat the ravages
of heart diseases in northern Nigeria.
Keywords:
rheumatic, congenital, heart surgery
Submitted 24/10/10, accepted 13/3/12
Published online 27/3/12
Cardiovasc J Afr
2012;
23
: 432–434
DOI: 10.5830/CVJA-2012-028
Northern Nigeria, with over 50% of the nation’s estimated
150
million population, has several tertiary-care hospitals but
none has the capacity for open-heart surgery to service the
large number of indigent patients affected by the ravages of
rheumatic and congenital heart diseases. These patients therefore
have a grim prognosis and many face untimely death, with the
exception of a minority who have the financial resources or are
able to obtain government or private sponsorship to travel abroad
for the recommended surgical treatment.
Medical treatment is the only available option and is often
palliative, with many patients requiring frequent hospitalisations
for congestive heart failure and with a resultant poor quality of
life. Because of this dismal outlook, the Global Eagle Foundation,
a US-based non-governmental organisation, in partnership with
the Nigerian Government, decided to undertake a pilot project on
the feasibility of establishing a heart programme to fill this void
and bring hope to these patients.
This report summarises our initial experience with the
first series of open-heart surgeries ever performed in northern
Nigeria.
Methods
Between October 2006 and April 2008, patients referred with
heart diseases to the Cardiology Division of the National
Hospital, Abuja andAhmadu Bello University Teaching Hospital,
Zaria, were screened and potential surgical candidates were
shortlisted. After further evaluation, patients testing positive
for HIV/AIDS and hepatitis B and C were excluded. Due to the
limited resources, the more symptomatic patients were selected
to undergo surgery.
Diagnosis was established non-invasively through clinical
examination and confirmed by transthoracic echocardiogram
(
TTE). Transoesophageal echocardiogram (TEE) and cardiac
catheterisation were not available then at either institution. All
the valvular patients met the American College of Cardiology/
American Heart Association (ACC/AHA) class I indications for
surgery.
During the three missions, each lasting about one week, 18
patients comprising 12 (66.7%) females and six (33.3%) males,
with age range five to 42 years (mean 17.6 years), underwent
heart surgery. Twelve (66.6%) patients had acquired heart
diseases, predominantly rheumatic valvular disease and six
(33.3%)
had congenital heart disease, of whom 55.5% (10/18)
were either in NYHA class 3 or 4 pre-operatively (Table 1).
The EURO score was used for risk stratification in the valve
patients, with a mean score of 5.51, and range of 3.13–12.04.
Invasive monitoring was by arterial and central venous pressure
lines, with a swan ganz catheter and cardiac output measurements
used sparingly due to limited supply.
Surgical exposure was through a median sternotomy for
patients requiring the heart–lung machine. Cardiopulmonary
bypass was via ascending aortic and atrial–bicaval cannulations.
Moderate systemic hypothermia at 30°C was used in all patients
and myocardial protection during aortic cross clamping was by
cold-blood cardioplegia administered antegrade, retrograde or
both.
Standard blood-conservation techniques used included,
whenever possible, retrograde priming of the pump with
removal of blood and cell saver. Two patients received low-dose
aprotonin. The blood banks did not have the capability to provide
component blood therapy and therefore only whole blood
was available to transfuse for either anaemia or coagulopathy.
Postoperative follow up was by clinic visits or telephone calls
and was completed in 87.5% of surviving patients.
Results
Of the 18 patients undergoing surgery, 16 (88.8%) completed
the planned operative procedure. Two patients were deemed
inoperable after sternotomy due to supra-systemic pulmonary
Section of Cardiothoracic Surgery, St Joseph’s Hospital,
Atlanta, Georgia, USA
J NWILOH, MD,
Ahamadu Bello University Teaching Hospital, Zaria, Nigeria
S EDAIGBINI, MD
S DANBAUCHI, MD
M AMINU, MD
A OYATI, MD
National Hospital, Abuja, Nigeria
I BABANIYI, MD
Y ADAMU, MD
