Intraoperative Management of a Patient Undergoing Cardiac Surgery in Sao Luis Public Hospitals in Brazil versus to that Seen at an Isolated Cardiac Institute in Tanzania: A Comparative Study between Centers of Middle and Low-Income Countries

Introduction: In low income countries of Africa where there no adequate cardiac facilities and expertise, lack of adequate data for patients with cardiac disease, the pattern of cardiac disease is not well known, but a continuum attendance of patients seeking medical care prevails. While we know quite well the disease process and profile for developed countries where there is adequate and published data we lack adequate knowledge to compare the surgical technique that is used in middle income countries. The objective of this study was to compare the disease pattern and surgical technique as seen in a newly established Cardiac Institute, The Jakaya Kikwete Cardiac institute located within the Muhimbili National Hospital in Tanzania and patients seen at three public Hospital in Sao Luis Brazil. Patient and Methods: This was a retrospective study that reviewed all cases seen by the author during his fellowship training at The Federal University Hospital of Maranhao and compared to cases seen at the Jakaya Kikwete Cardiac institute, in Dar es Salaam Tanzania. All patients that were either managed by local adult surgeons or by visiting team in a form of surgical mission were included into the study. Patient were seen at various occasions in Sao Luis public Hospital represented by State hospital, the Hospital Dr. Carlos Macieira, The Federal University of Maranhao and Santa Casa de Misericordia-Hospital do Coracao. Patients included in this study were the case only whom the author took part in their surgical interventions. Data Collection: Data were collected and entered into a structured data sheet in an SPSS program and analyses using the program. Results were obtained constructed in tabular form, discussed and a conclusion was drawn. Results: The study showed a difference in mean age between the two treatment centers. Coronary ischemic heart disease was more frequently observed in middle economic country than in lower economic country, which in turn showed more rheumatic valvular heart disease. There was high efficiency in performing cardiac surgeries in the middle economic country as compared to the low economic country. No difference in terms of mortality was observed between the centers. Conclusion: The use of intermittent aortic cross-clamp a technique that is based on myocardial ischemic preconditioning is a modern, safe and effective technique to use during coronary revascularization.