• JaBaris D Swain, Daniel N Pugliese, Joseph Mucumbitsi, Emmanuel K Rusingiza, Nathan Ruhamya, Abel Kagame, Gapira Ganza, Patricia C Come, Suellen Breakey, Bonnie Greenwood, Jochen D Muehlschlegel, Cecilia Patton-Bolman, Agnes Binagwaho, and R Morton Bolman.
• Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA, jdswain@partners.org.
• World J Surg. 2014 Sep 1;38(9):2205-11.

ImportanceRheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD.ObjectiveWe describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda's current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD.Evidence ReviewInterviews with key personnel and review of administrative records were conducted to obtain qualitative and quantitative data on the recruitment of clinical personnel, procurement of equipment, and program finances. The number of surgical cases completed and the resultant clinical outcomes are reviewed.FindingsFrom 2008 to 2013, six annual visits were completed. A total of 128 prosthetic valves have been implanted in 86 complex patients in New York Heart Association (NYHA) class III or IV heart failure, with excellent clinical outcomes (5 % 30-day mortality). Postoperative complications included a cerebrovascular accident (n = 1) and hemorrhage, requiring reoperation (n = 2). All procedures were performed with participation of local personnel.Conclusions And RelevanceThis strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.

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