BACKGROUND:
The Caribbean is a multi-ethnic society including Caucasian, Afro-Caribbean, East Indians,
Asians, Hispanics, Europeans and natives with a broad range of living standards. The Central
Statistical Office of Trinidad and Tobago’s (T&T) last census (2000) reported a total population
of 1,262,400 inhabitants with an average 0.7% annual growth rate, being 40% East Indian
descendants, 37% African, 20% Mixed, 0.6% Caucasian and 0.3% Chinese. The incidence and
types of heart disease vary significantly amongst these races. We report the surgical
experience (adult and paediatric) of a low volume multi-ethnic population service based in T&T.
OBJECTIVE:
Heart surgery in a multi-ethnic low volume service can be performed with excellent results
comparable to international standards for adults and paediatrics.
METHODS:
The Adult Heart Surgery Program started in November 1993 when only two cases were
performed and increased to 174 cases in 2004. The data on a total of 8778 cases (629 male,
median age 67, age range 18 to 88 years old) is reported. The procedures include CABG, valve
repair and replacement, and major aortic surgery including emergency dissection. The
Paediatric Heart Surgery Program started in September 1998 and a total of 279 operations have
been performed (age range, 2 weeks to 21 years old).RESULTS:
Adult
Overall mortality was 3.8%. The majority of procedures were CABG (82.3%). The mean
number of grafts per patient was 2.6 with an overall mortality of 2.8% (0% in 2004). Off
pump surgery, which was introduced in 1997, accounts for 43% of the total procedures
(71.2% in 2004). Aortic valve surgery was carried out in 49 patients and mitral valve
replacement/repair in 96, with or without CABG.
Paediatric
The majority of the procedures were VSD 111, ASD 57, TOF 23, and 88 others (including AV
canal, BT shunt and coarctation) with an overall mortality of 1.5%.
CONCLUSIONS:
Heart surgery in a multi-ethnic low volume service can be performed with excellent results
comparable to international standards for adults and paediatrics.