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While high-income countries benefit from mature national registries and well-established benchmarking systems, low- and middle-income countries (LMICs), which carry the largest global burden of congenital heart disease, continue to face significant challenges in data collection. This narrative review examines the current evolving data landscape for congenital heart surgery in LMICs, explores the relationship between existence of data systems and QI, identifies persistent barriers to data collection, and proposes context-appropriate strategies for sustainable progress. Evidence from published outcome studies, national and regional registry reports, and some major international databases demonstrates encouraging growth in progressive maturation of data systems across LMICs. Importantly, successful models illustrate that even incremental data collection, when focused on high-impact indicators such as mortality, major morbidity, and hospital length of stay, can generate meaningful improvements when linked with local clinical leadership, simple audit mechanisms, and collaborative learning networks. Although comprehensive, high-fidelity data collection may be unrealistic in many resource-constrained environments, the pursuit of perfection should not impede progress. Stepwise, local data strategies, supported by international collaboration, capacity building, and context-sensitive implementation, offer a realistic and transformative pathway toward safer, more equitable congenital cardiac care in LMICs.<\/jats:p>","DOI":"10.1177\/21501351261444019","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T12:35:14Z","timestamp":1779280514000},"page":"834-842","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Quality Improvement in Congenital Heart Surgery Requires Data: Is This Asking too Much in Low- and Middle-Income Countries?"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8281-4400","authenticated-orcid":false,"given":"Debasis","family":"Das","sequence":"first","affiliation":[{"name":"Narayana Hospital(Narayana Health)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1996-2800","authenticated-orcid":false,"given":"Shubhadeep","family":"Das","sequence":"additional","affiliation":[{"name":"Narayana Hospital(Narayana Health)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3209-0261","authenticated-orcid":false,"given":"Bistra","family":"Zheleva","sequence":"additional","affiliation":[{"name":"Children's HeartLink"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivakumar","family":"Sivalingam","sequence":"additional","affiliation":[{"name":"National Heart Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulisses Alexandre","family":"Croti","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology and Cardiovascular Surgery Service, S\u00e3o Jos\u00e9 do Rio Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"Cury","sequence":"additional","affiliation":[{"name":"CardioPedBrasil\u00ae \u2013 Centro do Cora\u00e7\u00e3o da Crian\u00e7a \u2013 Hospital da Crian\u00e7a e Maternidade de S\u00e3o Jos\u00e9 do Rio Preto (FUNFARME), \u2013 Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP), S\u00e3o Jos\u00e9 do Rio Preto, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna Subramony","family":"Iyer","sequence":"additional","affiliation":[{"name":"Fortis Escorts Heart Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRC.148.suppl_1.19043"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30386-3"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.07.037"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/2150135111426732"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/21501351231204333"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjcpc.2023.10.001"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.05.007"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.31083\/RCM43778"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.21037\/asj-22-30"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-08342-2"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-022-03041-5"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.32604\/chd.2025.064790"},{"issue":"10240","key":"e_1_3_2_14_2","first-page":"1735","article-title":"2017 Congenital heart disease collaborators. 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