We propose several considerations for implementation of critical congenital heart disease (CCHD) screening for low- and middle-income countries to assess health system readiness for countries that may not have all the downstream capacity needed for treatment of CCHD. The recommendations include: (1) assessment of secondary and tertiary level CHD health services, (2) assessment of birth delivery center processes and staff training needs, (3) data collection on implementation and quality surgical outcomes, (4) budgetary consideration, and (5) consideration of the CCHD screening service as part of the overall patient care continuum.
Isolated reports from low- and middle-income countries (LMIC) for surgical results in Tetralogy of Fallot (TOF) are available. The International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) seeks to improve surgical results promoting reductions in infection and mortality in low and middle income countries.All cases of TOF in the IQIC database performed between 2010 and 2014 at 32 centers in 20 LMIC were included. Excluded from the analysis were TOF with any associated lesions. A logistic regression analysis was performed to identify risk factors for in-hospital mortality after surgery for TOF.A total of 2164 patients were identified. There were 1,839 initial primary repair, 200 with initial systemic to pulmonary artery shunt and 125 underwent secondary repair following initial palliation. Overall mortality was 3.6% (78/2164), initial primary repair was 3.3% (60/1839), initial systemic to pulmonary artery shunt 8.0% (16/200) and secondary repair 1.6% (2/125); (p = 0.003). Major infections occurred in 5.9% (128/2164) of the entire cohort. Risk factors for mortality following initial primary repair were oxygen saturation < 90 and weight/body mass index for age below the 5th percentile (p < 0.001). Over half, 54% (991/1839) underwent initial primary repair after 1 year of age. Older age at initial primary repair was not a risk factor for mortality (p = 0.21).In LMIC, TOF patients are often operated after age 1 year, unlike developed countries older age is not a risk factor for mortality. Nutritional and hypoxemic status were associated with higher mortality and infections. This information fills a critical knowledge gap for surgery in LMIC .