Improving postoperative outcome of congenital heart surgery in low/middle-income countries: climbing mount excellence

Congenital cardiac defects continue to be a major cause of death and suffering in the low/middle-income countries.1 This stems from the larger burden of congenital heart defects in these countries,2 coupled with the paucity of specialised centres and the reported worse outcome of operations in the existing centres. These facts have stimulated concerted efforts to establish new sustainable centres3 and, importantly, developing strategies to improve outcome in the existing centres.

The Heart paper by Khan and colleagues4 is a welcome addition to the literature as it highlights the advantages, as well as limitations, of applying some of the recommendations of a collaborative programme developed by workers at Boston Children Hospital, and currently being applied completely, or in part, by 28 centres in low/middle-income countries.5 The authors report the effect of applying some of these recommendations, including enhancing hospital infection control...