AMPATH Partners Expand Complex Valvular Heart Surgery Capacity at MTRH
Two hundred and twenty young adults in need of cardiac surgery primarily due to damage from rheumatic heart disease (RHD) will receive the life-saving surgery over the next two years through a collaboration between AMPATH partners Moi Teaching and Referral Hospital (MTRH), Moi University, Indiana University and the University of Texas at Austin Dell Medical School.
RHD is a leading cause of heart-related death and illness worldwide with a disproportionate number of cases in sub-Saharan Africa often occurring in adolescents and young adults as the result of undiagnosed strep infections (streptococcal sore throat).
The AMPATH Kenya cardiothoracic surgery team operates at Moi Teaching and Referral Hospital.
“This collaborative effort literally gives the gift of life to those who receive this surgery,” said Adrian Gardner, MD, MPH, director of the Indiana University Center for Global Health Equity and executive director of the AMPATH Consortium. The costs associated with the surgeries including equipment and supplies, clinical management, training and travel will be supported by a grant from the Michael & Susan Dell Foundation.
Over the past 15 years, in collaboration with AMPATH partners led by Duke University, MTRH has established a center of excellence in cardiology care including an inpatient cardiac care unit and comprehensive cardiology clinic that sees over 200 patients per week with a significant percentage of them having RHD. Patients are referred from throughout Kenya and the vast majority are in dire nA formal cardiology fellowship program at Moi University trains two cardiologists per year and is not in its fourth cycle.
Surgical equipment is prepared for heart surgeries.
While sporadic cardiac surgery was performed in the past, a structured cardiothoracic surgery collaboration between MTRH/Moi University surgeons and Emily Farkas, MD, (IU) and Rob Neely, MD, (UT) began in 2022 and has performed more than 50 complex surgeries. These efforts were built upon the vision established by Professor Barasa Otsyula (MTRH) and Dr. James Munene (Kenyatta National Hospital) in 2018, with the charge now passed to Stephen Ondigo, MBChB, MMed (surgery) and his team of young surgical colleagues.
The cardiology team works closely with the cardiothoracic surgery team to identify appropriate candidates for surgical intervention. Due to the efforts of this collaboration, MTRH became the institution performing the highest number of cardiac surgeries in the country in 2023.
“Access to complex multi-valvular cardiac operations in Kenya and other low resource countries is severely lacking” said Dr. Farkas, associate director of global health in surgery at the IU School of Medicine, who travels frequently to MTRH. “There is an urgent need to enhance surgical capacity, as well as to monitor and identify patients in need of surgical intervention early.” Dr. Farkas and Dr. Gardner are the principal investigators from Indiana University for the Dell Foundation grant.
“This additional funding will enable multidisciplinary teams to expand and enhance the local capacity for sustainable, high-quality cardiac surgical care,” added Dr. Ondigo, chief of cardiothoracic surgery at MTRH and co-principal investigator on the grant. MTRH cardiologist Joan Kiyeng, MD, MMed, CFell Cardiology, and surgeon Stephen Takow, MD, MMed, are also co-principal investigators.
In addition to increased surgical reach and capacity building, the AMPATH partnership plans to:
Develop and implement a clinical protocol for routine echocardiograms in the cardiac/RHD clinic at MTRH to ensure optimal selection of surgery candidates and improve patient outcomes.
Establish a Picture Archiving and Communication System (PACS) system to track valvular disease progression more effectively, allowing for better decision-making regarding the timing of surgical interventions and enabling data-driven patient care.
Enhance imaging and optimize care during surgery, leading to improved surgical precision and outcomes.
Accelerate database efforts that measure quality initiatives through a comprehensive registry
“We are proud to support the efforts of AMPATH to provide valve replacement surgery for people with rheumatic heart disease,” said Aliya Hussaini, MD, MSc, head of health initiatives at Michael & Susan Dell Foundation. “Because this condition often strikes young people, this effort will have an immense positive impact that extends beyond the patients, to the patients' families and other members of the community.”