Viral cardiovascular surgical diseases: global burdens, challenges and opportunities

Abstract

Globally, more than one billion people are vulnerable to neglected tropical diseases, many of which have viral origins and cardiovascular implications. Access to cardiovascular care is limited in countries where these conditions are endemic. Six billion people lack access to safe, timely and affordable cardiac surgical care, whereby over 100 countries and territories lack a single cardiac surgeon. Moreover, while clinically unique, the surgical consequences of neglected cardiovascular diseases with viral origins have been poorly described in the current literature. This review provides an overview of the global burden of viral cardiovascular disease, describes access to cardiac surgical care in regions where these conditions are endemic, and further highlights surgical consequences and considerations to manage patients requiring cardiac surgical care.

Article Highlights

• Cardiovascular disease is the leading cause of morbidity and mortality in low-and middle-income countries (LMICs). Despite the considerable burden of neglected viral cardiovascular diseases, these conditions have largely gone unnoticed on the global health agenda.

• Myocarditis is the most common cardiovascular consequence of viral infection, with an estimated 1.8 million cases worldwide. In high-income countries, myocarditis is predominantly caused by viral infections, while in LMICs, it is more often attributed to bacterial and parasitic infections such as tuberculosis, Chagas disease, and malaria, alongside viral origins.

• Over six billion people lack access to safe, timely and affordable cardiac surgical care, as a result of geographical distance, no or limited infrastructural capacity, low-quality care and financial barriers.

• Myocarditis and acute and chronic inflammatory cardiomyopathy are two of the major etiologies of viral infections impacting the heart muscle. Progressive disease may require mechanical circulatory support and cardiac surgical care, which are poorly accessible in endemic areas.

• Community-driven and patient-centered efforts are necessary to meet the needs of communities most burdened by untreated cardiovascular viral diseases and avoid further divergence in terms of health status and outcomes, socioeconomic development and access to essential cardiovascular care.

• Multidisciplinary and international efforts, such as the NET-Heart Project, are growing to systematically study the link between neglected tropical diseases and cardiovascular diseases.

Keywords: :

• cardiac surgery
• cardiology
• cardiomyopathy
• cardiovascular disease
• global cardiac surgery
• global health
• global surgery
• myocarditis

Acknowledgments

D Vervoort is supported by the Canadian Institutes of Health Research (CIHR) Vanier Canada Graduate Scholarship for work outside this manuscript.

Author contributions

This statement certifies that all authors contributed to the following substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content; and final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.