Cardiac Surgery Competence at a Resource-Limited Tertiary Hospital in Nigeria: From Missions to Autonomy

Abstract

Background

Cardiac surgery requiring cardiopulmonary bypass began at Federal Medical Centre (FMC), Abuja, in February 2022 through visiting mission teams. Continuous collaboration between subsequent missions and local staff has led to progressive skills acquisition and increasing independence in both adult and pediatric cardiac surgery. This report outlines our path to independence and the challenges encountered.

Methods

From February 2022 to December 2024, we reviewed 45 patients who underwent cardiac surgery with cardiopulmonary bypass. Data included the operating team (visiting vs local), case type, and outcomes.

Results

Of 45 surgeries, visiting teams performed 27 (11 adult, 16 pediatric) and local surgeons performed 18 (5 adult, 13 pediatric). Six surgical missions were conducted. The proportion of cases done independently by local surgeons increased from 14.3% in 2022 (n = 7) to 26% in 2023 (n = 23), and 73% in 2024 (n = 15). Competence was achieved first by cardiologists, followed by scrub nurses, intensive care unit nurses, anesthetists, and surgeons. The local perfusionist has yet to attain independence, representing a major program limitation. Of 45 operations, nine mortalities (20%) occurred—five in visiting-team cases and four in local-team cases. All but one were pediatric, and all occurred postoperatively.

Conclusion

Structured collaboration with visiting missions, deliberate skills transfer, and perseverance have enabled rapid development of cardiac surgical competence at the Federal Medical Centre, Abuja. While adult and selected pediatric cases are now managed independently, further progress requires dedicated perfusionist training and improved pediatric postoperative care.