Cardiovascular Journal of Africa: Vol 30 No 3 (May/June 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019 AFRICA 161
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Cardiac surgery for the forgotten millions: the way forward
CSIA site-selection criteria
Forwarded by the CSIA members
Rheumatic heart disease (RHD) affects a disproportionate
number of people living in low- to middle-income countries
(LMIC) and exacts a heavy toll in terms of morbidity and
mortality in those afflicted. RHD is the most common
cardiovascular disease in young people worldwide, and a
majority of patients with acute rheumatic fever will develop
valvular heart disease and/or heart failure.
The Drakensberg Declaration, 1 which focused on primary
and secondary prevention, has made a significant impact
on RHD, however there remains a large number of patients
who develop structural heart disease for whom surgery is the
only effective treatment. Access to cardiac surgery remains
woefully limited or absent in the majority of LMIC. Hence
the magnitude of the suffering faced by the patients living in
these LMIC becomes apparent.
With an understanding that surgery is, and will remain, an
integral part of the management of RHD, ‘The Cape Town
Declaration on access to cardiac surgery in the developing
world’2 was unanimously adopted, signed and published in
all the major cardiothoracic journals. The Cardiac Surgery
Intersociety Alliance (CSIA) was created along the guidelines
of the first aim of the Cape Town Declaration (CTD) to be
the effector arm of the CTD.
The CSIA is composed of representatives from the major
cardiothoracic societies [the Society of Thoracic Surgeons
(STS), the American Association for Thoracic Surgery
(AATS),theEuropeanAssociationforCardiothoracicSurgery
(EACTS) and the Asian Society for Cardiovascular and
Thoracic Surgery (ASCVTS)], the World Heart Federation
(WHF) and an industry partner. The CSIA is charged with
evaluating, endorsing, mentoring and monitoring potential
sites in LMIC to increase access to cardiac surgery, as well as
training of providers at these sites.
To achieve this goal, a list of criteria for programme
selection by the CSIA was created and is included in this
publication. This list has been reviewed and ratified by the
leadership of all of the societies whose members make up
the CSIA. The tenets of the document embody the central
message of the CTD. The criteria list was created with the
goal of being collaborative with the sites while ensuring
commitment, engagement, transparency and sustainability
from the sites that are chosen. Any site chosen will ideally
have the five pillars of CSIA-supported projects, which are
the Driver (Champion), the Local Guarantor, the Sponsor,
the Training Site and the Academic Partner.
The initial plan is to select two to three pilot sites to
initiate the project. Once success and feasibility have been
demonstrated, CSIA will expand this project to additional
sites. The CSIA is looking for sites that are passionate,
dedicated and determined to establish an enduring, successful
partnership. The CSIA will be accepting applications until
15 July 2019. All programmes are encouraged to apply. If
not selected for the initial pilot site, all applications will be
entered into a database for consideration at a future date.
References
1. Mayosi B. Robertson K. Volmink J, Adebo W, Akinyore K, Amoah
A, et al. The Drakensberg Declaration on the control of rheumatic
fever and rheumatic heart disease in Africa. S Afr Med J 2006; 96: 246.
2. Zilla, P, Bolman, R, Yacoub, M, et al. Cape Town Declaration
on access to cardiac surgery in the developing world. J Thorac
Cardiovasc Surg 2018; 156(6): 2206–2209.