Open-heart surgery breaks new frontiers

Sifelani Tsiko-Innovations Editor

The progression and expansion of open-heart surgery in Zimbabwe is quite encouraging and has had tremendous growth saving lives and foreign currency that otherwise could have been spent abroad in various countries for life saving operations.

 Cardiac specialists at Parirenyatwa Group of Hospitals in Harare have so far managed to conduct 41 open-heart surgeries this year out of the targeted 60 operations for the year.

This target could have been realised had the team not suspended the operations for the emergency December peak operations.

“2024 has been a fairly good year for the open heart surgery program. Compared to 2023, we have been able to increase the number of cases by more than 300 percent,” Veteran cardiovascular and thoracic surgeon, Dr Wilfred Muteweye told The Herald recently.

“Our last case for 2024 was done on the November 25. December is usually reserved for emergency surgery cases. We usually have a lot of road traffic accident cases which require immediate attention in December so we didn’t book any elective surgery cases.

“We will resume the elective cases midJanuary 2025. Our target is to increase our caseload in 2025. We also hope to operate more and more children. We are hoping for more international collaborations with international colleagues (like we had with the Egyptian specialists.)”

The country resumed open-heart surgeries at Parirenyatwa Group of Hospitals last year in June after the service was stopped in 2018.

Zimbabwean cardiac specialists had initially targeted to perform 60 free open-heart surgeries this year as they scale up efforts to reduce the backlog of people needing treatment.

Before the resumption of the open–heart operations in Zimbabwe, patients in need of open-heart surgery had to fork out huge sums of money to seek treatment in South Africa, India, Kenya, Italy, Sudan and other countries.

A heart operation in India costs anything between US$8 000 to US$15 000, depending on the complexity of the case. The surgeries being conducted in Zimbabwe are done free of charge.

The country has between 500 and 600 adult patients with rheumatic heart disease awaiting surgery, while every year about 4 000 children are born with congenital heart deformities that need open-heart surgery.

“We are very grateful to the Ministry of Health and Child Care and the management of Parirenyatwa Group of Hospitals through Dr Tsitsi Magure (the Chief Medical Officer) for the support that they have given us,” Dr Muteweye said. 

 “We have also been fortunate to receive support from companies such as the National Oil and Infrastructure Company of Zimbabwe (NOIC). They have helped us in a big way to ensure that our patients do not have to pay for the open heart surgery.

“We are also grateful to Gift of Life International and Rotary Club for the support that they gave us during the paediatric open heart surgery camp. We hope to have more partners for the open heart surgery program.”

Open-heart surgery is costly. 

Consumables cost a lot of money and Dr Muteweye estimates that they need a minimum of US$4 000 per case.

“This can even double depending on the complexity of the case. Most of our patients cannot afford the surgeries. The support we are getting from the corporate world goes a long way in bringing this life saving surgery to the Zimbabweans,” he said.

“Our team comprising myself Dr Simukayi Machawira the team leader, Dr Kudzai Kanyepi (fellow cardiac surgeon), Drs Kajese and Mutetwa (our anaesthetists), the theatre scrub team, our perfusionist, the ICU team is excited because of the success that we have had. We hope to continue building on in 2025 and beyond.

“For 2025, we are targeting 75 cases. In total (including 2023) cases we have done 51 – 53 cases.”

Open heart surgeries have evolved by leaps and bounds in recent years breaking new frontiers for the medical field in the country.

Financial support and expertise are building up and enthusiasm for local open heart surgery is very encouraging.

“We wholeheartedly appreciate the efforts and time taken by local doctors in conducting life saving operations,” said one Harare beneficiary.

“I could have died and I want to thank our local doctors for saving my life.”

Every year, more than 4 000 children in Zimbabwe are born with congenital heart conditions that require open-heart surgery.

The country has a waiting list of up to 600 adult patients that need medical procedures.

“The world standard is to keep a single cardiothoracic surgeon competent. They need to operate on 150 cardiac patients annually. If we look at America and Western Europe, they perform about 1 300 cardiac surgeries per million, which is where I think we should aim for,” said Dr Muteweye.

“For us to be realistic, I think we are looking at plus or minus . . . to really get a functional cardiac unit we need something between US$12 and US$15 million. We once made a proposal and the Government floated a tender, which came to about US$12 million.

“For us to keep operating and to increase our numbers, we need to upgrade the equipment, the units, the machinery and other equipment. But we want to continue operating even as we are. We can still do a lot. The most important thing is that we must show the country and the world that we can do it locally.”

Zimbabwe’s new breed of trailblazing physicians and other healthcare specialists have made the nation proud and to stand on the shoulders of other giants who are offering open-heart surgery in Africa and across the world.

Today, about 28 African countries now offer open-heart surgery and 12 have running programs, while the others rely exclusively on visiting surgical teams.

“There are about 12 000 cardiac surgeons in the world and here in Africa we have less than 1 000. The disparity is so huge. Here in Zimbabwe we have five certified surgeons and one of them is no longer active due to age.

“Zimbabwe has one surgeon per five million people,” Dr Muteweye once remarked on the sidelines of a University of Zimbabwe Faculty of Medicine and Health Sciences guest lecture.

The first open-heart surgery in Africa was performed by South African surgeon Dr Christiaan Barnard in 1958 at Groote Schuur.

Africa is also famous for being the first continent in the world in which a successful heart transplant was performed.

In 1967, Barnard led the team that performed the world’s first human-to-human heart transplant.

The first open-heart surgery case in Zimbabwe was done in 1959 using deep hypothermic circulatory arrest (ice bath) for pulmonary valvotomy by surgeons N Micklem and G Wright.

The operation was done on a 15-year-old boy during the Rhodesian era. The patient had pulmonary valvotomy with surface cooling and recovered well following the surgery.

In the 1970s and 80s, cardiac surgery was done by medical missions from Loma Linda University in the United States.

The missions only provided cardiac surgery to a few and were largely donor-dependent. Dr Muteweye said it was difficult to sustain these missions and over time there was pressure to develop local provision of service of cardiac surgery.

In 1988, Loma Linda University sent a core team that helped establish a local resident team that carried out several cases of open heart surgery with success.

Training was done locally and in collaboration with other international cardiac centres resulting in the establishment of a joint team. The teams began the open-heart surgery in 1989 and were able to leave behind a team that successfully continued the efforts.

Between 1989 and 1992, they managed to operate 91 cases of open-heart surgery with a mortality rate of 8.7 percent. The locally assembled team carried out more than 400 open-heart surgeries between 1995 and 2003 and operated on a weekly basis.

But the difficult economic situation and economic sanctions imposed by the West forced the programme to end in 2003.

“In 2003, the programme ceased to operate due to lack of financial support. The period 2003 to 2016 was like a dark age for open-heart surgery in Zimbabwe,” Dr Muteweye said.

Efforts to resuscitate open-heart surgery only resumed in February 2016 after a 13-year period.