58 / 76
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
256
AFRICA
Report
The Cape Town Declaration on Access to Cardiac
Surgery in the Developing World
Peter Zilla, R Morton Bolman, Magdi H Yacoub, Friedhelm Beyersdorf, Karen Sliwa, Liesl Zühlke,
Robert SD Higgins, Bongani Mayosi, Alain Carpentier, David Williams
Mission:
to urge all relevant entities within the international
cardiac surgery, industry and government sectors to commit
to develop and implement an effective strategy to address the
scourge of rheumatic heart disease in the developing world
through increased access to life-saving cardiac surgery.
Cardiovasc J Afr
2018;
29
: 256–259
www.cvja.co.zaDOI: 10.5830/CVJA-2018-046
Twelve years after cardiologists and cardiac surgeons from all
over the world issued the DrakensbergDeclaration on the Control
of Rheumatic Fever and Rheumatic Heart Disease in Africa,
calling on the world community to address the prevention and
treatment of rheumatic heart disease (RHD) through improving
living conditions, to develop pilot programmes at selected sites
for control of rheumatic fever and rheumatic heart disease, and
to periodically review progress made and challenges that remain,
1
RHD still accounts for a major proportion of cardiovascular
diseases in children and young adults in low- and middle-income
countries, where more than 80% of the world’s population live.
Globally equal in prevalence to human immunodeficiency virus
infection, RHD affects 33 million people worldwide.
2
Prevention efforts have been important but have failed to
eradicate the disease. At the present time, the only effective
treatment for symptomatic RHD is open-heart surgery, yet that
life-saving cardiac surgery is woefully absent in many endemic
regions. In this declaration, we propose a framework structure to
create a co-ordinated and transparent international alliance to
address this inequality.
Elimination of RHD and relief from its debilitating
consequences can only occur through interdisciplinary effort,
as outlined in the Cairo Accord.
3
Previous initiatives have
focused on primary and secondary prevention of RHD.
4
Their
declarations have been recognised by the heads of state of African
Union countries and by the World Health Organisation. This
recognition has been important in developing recommendations
by the World Health Organisation executive board to the 2018
World Health Assembly to enlist global commitment to RHD.
Progress in the prevention of RHD has been slow during the
past 15 years,
5
and therefore surgery will likely remain an integral
part of RHD treatment for several generations. Lack of access to
cardiac surgery services and the cost of valve replacement render
this disease fatal for millions of patients. In endemic regions of
low-income countries, the need for cardiac surgery is estimated at
300 operations per one million population (Global Unmet Needs
in Cardiac Surgery, unpublished work by Zilla and colleagues),
yet, the nearly one billion people living in sub-Saharan Africa
between the Maghreb and South Africa have access to only 22
cardiac centres.
6
Although there is one cardiac centre per 120 000 people in the
United States, there is only one centre per 33 million in Africa.
Furthermore, RHD is not restricted to sub-Saharan Africa.
India, Pakistan, China and Indonesia together account for 72%
of the mortality rate of RHD cases worldwide.
2
Christiaan Barnard Division of Cardiothoracic Surgery,
Faculty of Health Sciences, University of Cape Town, Cape
Town, South Africa
Peter Zilla, MD, PhD,
peter.zilla@uct.ac.zaDivision of Cardiothoracic Surgery, University of Vermont,
Burlington, Vermont, USA
R Morton Bolman, MD
Chain of Hope, Chelsea, London, United Kingdom
Magdi H Yacoub, MD
Department of Cardiovascular Surgery, Universitäts-
Herzzentrum Freiburg–Bad Krotzingen, Freiburg, Germany
Friedhelm Beyersdorf, MD
Hatter Institute of Cardiovascular Research in Africa,
Faculty of Health Sciences, University of Cape Town, Cape
Town, South Africa
Karen Sliwa, MD, PhD
Division of Paediatric Cardiology, Department of
Paediatrics and Child Health, University of Cape Town,
Cape Town, South Africa
Liesl Zühlke, MB ChB, PhD
Department of Surgery, Johns Hopkins Medicine,
Baltimore, Maryland, USA
Robert SD Higgins, MD
Faculty of Health Sciences, University of Cape Town, Cape
Town, South Africa
Bongani Mayosi, MD
Hôpital Européen Georges Pompidou, Paris, France
Alain Carpentier, MD
Wake Forest Institute of Regenerative Medicine, Wake Forest
School of Medicine, Winston-Salem, North Carolina, USA
David Williams, PhD