“Global Access to Cardiac Surgery: the South leads the North”
More than 6 billion people live outside industrialised countries and have insufficient access to cardiac surgery. The overwhelming majority of these patients suffers from rheumatic heart disease (RHD) leading to a premature death at relatively young age in a significant proportion of the estimated 33mio patients worldwide. As such, RHD affects the same number of patients as HIV/AIDS.
In a multi-institutional effort representing 16 countries we assessed the need estimates for open heart surgery in low-income countries to be in the range of 200 operations per million. Actually provided levels of cardiac surgery, however, can be as low as 0.5/million. By combining need estimates with the assessment of de-facto provided levels of cardiac surgery, it emerged that to a significant degree, under-delivery of often life-saving open heart surgery does not only prevail in low-income countries but is also disturbingly high in middle income countries.
As socioeconomic circumstances of these countries will never allow to build and maintain the > 4,000 new heart centres needed, tailormade and affordable alternative solutions are required. Ten-years of efforts at the University of Cape Town led to the development of polymer-based trans-catheter heart valves that are durable in young patients and can be easily inserted in low-income countries in the absence of cardiac surgery. Clinical trials are about to commence.
While none of the contemporary first-world solutions are suitable for the low basic skills and infrastructure prevailing in low income countries, tailor-made solutions for the poorer part of humanity may have something to offer the rich world, such as affordability, independence from sophisticated imaging equipment, durability and simplicity.
About Peter Zilla
After graduating as “Doctor of Medicine” at the University of Vienna in 1980 he obtained a Dr. Med. degree from the University of Zurich in 1983, a PD degree (Habilitation) from the University of Vienna and a PhD degree from the University of Cape Town in 1990. Clinically, he has been registered as a specialist general surgeon since 1988, vascular surgeon since 1990 and cardiothoracic surgeon since 1992.
After he spent his initial three post-graduate years in basic science he commenced his surgical career with his residency at the University Hospital Vienna from 1983 to 1989. His subsequent surgical positions were as Senior Registrar at the Department of Cardiovascular Surgery, University Hospital Zurich (1989-1990) followed by staff surgeon positions in Austria and Cape Town where he has been Head of the Chris Barnard Department of Cardiothoracic Surgery for the past two decades.
Pioneering tissue engineering since 1983, his group developed a method of culturing the patient’s own endothelial cells on prosthetic surfaces. Addressing the need for ‘home grown’ solutions for patients in developing countries who have no access to cardiac surgery, Professor Zilla co-founded a University of Cape Town Start-Up Company in 2008.
Professor Zilla is author of 200 peer reviewed full papers and patents (104 times first author or corresponding author) with almost 10,000 citations and an H-index of 45. Apart from >40 filed or issued US/PCT patents he is the editor of 5 books and has authored numerous book chapters. He obtained international academic and industry grants of almost >14 million Euros and secured 20mio Euros for his University start-up company since 2008. For his research he has been awarded the Theodor Billroth Award (Austrian Surg Soc); Sigma Tau Award (Intern.Union of Angiology); Alexis Carrel Award (German Soc Vasc Surg); Goetz Award (SA Cardiac Soc); Eiselsberg Award (Austrian Physicians Assoc) and Alain Carpentier Award (Int.Soc.Heart Valve Dis). He was the organizer of 6 major international conferences in 4 different countries; is a member and executive council member of 10 international societies; was president of ISACB from 1994-98; is a regular reviewer of the 18 top journals in his field and is on the editorial board of 3 major international journals and was Associate Editor of ‘Biomaterials’ (IF 8).
Ludwig Boltzmann Cluster for Cardiovascular Research
Center for Biomedical Research (Medical University of Vienna)
Host: Bruno Podesser