{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T18:08:37Z","timestamp":1770142117633,"version":"3.49.0"},"reference-count":79,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing \u201cCape Town Declaration\u201d constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of \u2018assisting only\u2019. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its \u2018Seal of Approval\u2019 for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.<\/jats:p>","DOI":"10.1093\/ejcts\/ezae048","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T13:03:30Z","timestamp":1718024610000},"source":"Crossref","is-referenced-by-count":3,"title":["Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA)"],"prefix":"10.1093","volume":"65","author":[{"given":"R M","family":"Bolman","sequence":"first","affiliation":[{"name":"Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota , Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9502-4109","authenticated-orcid":false,"given":"P","family":"Zilla","sequence":"additional","affiliation":[{"name":"Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town , Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F","family":"Beyersdorf","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University , Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2758-3237","authenticated-orcid":false,"given":"P","family":"Boateng","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center , New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Bavaria","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Dearani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mayo Clinic , Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Pomar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University of Barcelona , Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences , Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Chotivatanapong","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Central Chest Institute of Thailand and, Bangkok Heart Center , Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8272-0911","authenticated-orcid":false,"given":"K","family":"Sliwa","sequence":"additional","affiliation":[{"name":"Cape Heart Institute and Division of Cardiology, University of Cape Town , Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J L","family":"Eisele","sequence":"additional","affiliation":[{"name":"World Heart Federation (WHF) , Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Z","family":"Enumah","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Johns Hopkins School of Medicine , Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B","family":"Podesser","sequence":"additional","affiliation":[{"name":"Center for Biomedical Research and Translational Medicine, University of Vienna , Vienna, Austria"},{"name":"Department of Cardiothoracic Surgery, University Hospital St. P\u00f6lten, St. P\u00f6lten , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E A","family":"Farkas","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Indiana University School of Medicine , Indianapolis, IN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Kofidis","sequence":"additional","affiliation":[{"name":"Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. 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