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The availability of congenital heart surgeons (CHS) relative to paediatric population needs is poorly defined. A cross-sectional study of the Cardiothoracic Surgery Network was conducted across 194 United Nations-recognised countries and 54 territories and dependencies (T&amp;Ds). Of 248 countries and T&amp;Ds analysed, 123 (49.6%) had\u2009\u2265\u20091 CHS. A total of 4,296 CHS were identified; 71 (37% of recognised) countries with 189.5\u00a0million children had none. Low-income countries had a median of 0.15 CHS per million children compared with 9.29 in high-income countries. CHS density was strongly correlated with gross domestic product per capita. Average CHS ratios per million children were: high-income country 9.3, upper-middle-income country 2.0, lower-middle-income country 1.1, and low-income country 0.2 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), representing a 46-fold disparity between high-income countries and low-income countries. Regional analysis showed North America and Europe had the highest CHS ratios (\u2265\u20099 per million), and Sub-Saharan Africa and East Asia and Pacific had medians of zero (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Only 3 T&amp;Ds reported at least one CHS. Our findings confirm that human resource levels are even more disproportionate than previously estimated. A significant proportion of children globally remain without access to cardiac surgery, representing a major and largely unquantified burden of preventable morbidity and mortality. Accurately quantifying this unmet need should be an urgent priority for future population-level and health systems research.\n                  <\/jats:p>","DOI":"10.1007\/s00246-026-04523-6","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:30:05Z","timestamp":1792150205000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Congenital Cardiac Surgical Workforce Inequities Across 194 Countries: A Global Cross-Sectional Analysis"],"prefix":"10.1007","author":[{"given":"Jeevan","family":"Francis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio F.","family":"Corno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed.","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"23","key":"4523_CR1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000020593","volume":"99","author":"W Wu","year":"2020","unstructured":"Wu W, He J, Shao X (2020) Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990\u20132017. 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