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Clinical Overview

The Division treats almost exclusively indigent patients who have no medical insurance and as such are dependent on public hospitals. Adult cardiac patients typically represent three categories: indigent urban patients with mostly first-world life-style-related pathologies; indigent rural patients with mostly third-world pathologies; and congenital heart defects.

In the Adult Thoracic Service, although we see the whole spectrum of ‘first-world’ pleuro-pulmonary and oesophageal diseases, we also have a large patient load of infectious diseases and their sequelae. In addition, we see some conditions in unusual numbers, for example squamous carcinoma of the oesophagus, and pleural mesothelioma.

The Paediatric Cardiac service, whilst predominantly addressing congenital cardiac lesions, also sees many rheumatic cardiac valve lesions. Paediatric Thoracics has a mainly infectious diseases load, though also sees the full spectrum of non-cardiac congenital and malignant chest diseases.

Adult Cardiac and Thoracic patients are attended to at Groote Schuur Hospital and the Paediatric Cardiac and Thoracic service is based at the nearby Red Cross Children’s Hospital. Most of our surgeons cover at least two of the sub-disciplines. Half the surgeons cover both cardiac and thoracic conditions in adults, and two thirds of the paediatric surgeons operate on both adult and paediatric cardiac patients. Rather few cases are performed at the UCT Private Academic Hospital.

After more than a decade of government-orchestrated stagnation, the gap to a modern cardiothoracic service was narrowed in recent years with the adoption of: Video Assisted Thoracic Surgery (VATS), trans-catheter aortic valve replacements (TAVR/TAVI), minimally invasive mitral valve surgery, and a drive towards primary early repair of congenital heart defects. Moreover, heart transplantation has been stepped up after a steep decline in the previous decade and a revival of our lung transplant program as well as extracorporeal membrane oxygenation (ECMO) for paediatric and adult cardiac surgery are in the final planning stages.