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Research Snapshot Theater: Cardiovascular, Pediatric III

Achieving High-Quality Congenital Heart Surgery Outcomes in Resource-Constrained Settings

Tuesday, March 24, 2026
11:15 AM - 12:15 PM Central Time
Location: Connections Central - RST 07
  • BB

    Brooke Bidwell, MD, MPH (she/her/hers)

    Case Western Reserve/Rainbow Babies and Children’s Hospital

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • AP

    Alistair Phillips, MD

    Director of Quality Assurance for Pediatric and Congenital Heart Surgery
    Cleveland Clinic

    Disclosure information not submitted.

  • BT

    Betsy Tirado, RN

    Logistics Director
    Heart Care International

    Disclosure information not submitted.

  • MF

    Margaret Feldmeth, MSW

    Executive Director
    Heart Care International

    Disclosure information not submitted.

  • RM

    Robert Michler, MD

    Surgeon-in-Chief, Chairman of the Department of Surgery and Cardiovascular & Thoracic Surgery
    Montefiore Medical Center and Albert Einstein College of Medicine

    Disclosure information not submitted.

  • Kenneth Remy, MD, MSc, MSCI, FCCM

    Case Western Reserve University/University Hospitals Cleveland Medical Center, Ohio

    Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Congenital heart disease (CHD) is a leading cause of pediatric morbidity and mortality globally, with disproportionate burden in low- and middle-income countries (LMICs). Although surgical mortality in high-income countries (HICs) has dropped below 3%, data from LMICs remain limited. This study evaluates outcomes of congenital heart surgeries performed through an international partnership model in Latin America, aiming to assess performance relative to global benchmarks.


Methods: We conducted a retrospective analysis of 280 pediatric patients who underwent CHD surgery in El Salvador, Mexico, and Peru from 2015 to 2019, as part of Heart Care International’s mission-based program. Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores were retrospectively assigned to stratify procedural complexity. Primary outcomes included observed versus expected mortality and length of hospital stay (LOS). Data were compared across countries and over time.


Results: The cohort had a mean age of 5.1 years and mean weight of 17.95 kg. The average RACHS-1 score was 1.67, with increasing complexity observed in later years. Despite a predicted cohort mortality of 3.8%, the overall observed mortality was 1.05%. Mexico demonstrated 100% survival across all years despite the highest average RACHS-1 scores (1.81). Peru and El Salvador also achieved high survival rates (98.6% and 98.3%, respectively). Length of stay remained within global standards (mean: 4.09 days), and higher-complexity procedures were associated with longer LOS.


Conclusions: This study demonstrates that high-quality CHD surgical outcomes are achievable in LMICs through sustained, capacity-building global partnerships. Observed mortality rates were significantly lower than expected and comparable to HIC benchmarks, even for moderately complex procedures. These findings support the expansion of equitable, long-term collaborations that prioritize local expertise, infrastructure investment, and perioperative system strengthening to sustainably improve pediatric cardiac outcomes in resource-limited settings.