Oxygenators supporting cardiovascular surgeries
Zambia, located inland on the southern portion of the African continent, suffers from lagging development of medical infrastructure coupled with a lack of medical professionals capable of providing advanced medical services. For these reasons, patients requiring treatment are constantly unable to receive adequate medical services.
University Teaching Hospital (UTH), the national hospital that provides Zambia’s most advanced and specialized medical services, is also faced with a severe lack of medical professionals. UTH is the only hospital in Zambia at which patients can undergo cardiovascular surgeries. In the past, these surgeries have been performed purely by teams of foreign surgeons or visiting surgical teams and only in small numbers, and the necessary surgical techniques were not transferred to Zambian surgeons. As a result, over 200 children with heart diseases are still on waiting lists for surgery.
Tokushima International Cooperation (TICO) is a nonprofit organization that has been providing medical support to Zambia for a number of years. Seeking to address this situation, TICO partnered with UTH in 2017 to commence a program for cultivating a cardiovascular surgery team comprising Zambian surgeons. As part of this program, TICO invited surgeons from Japan to provide intensive training for Zambian surgeons and nurses beginning in September 2017. The goal of this training was to endow these individuals and other Zambian medical staff with the skills needed to perform open heart surgeries.*1 In February 2018, the first surgery for treating atrial septal defect*2 to be conducted by Zambian surgeons took place at UTH. Such surgeries have already been conducted on three female patients aged nine, 10, and 18. These three open heart surgeries were performed over a period of four days by a Zambian surgical team consisting of four surgeons, two nurses, and one clinical engineer. Support was provided by Japanese surgeons invited by TICO. The surgeries took longer than normal, but they were able to be completed safely through coordination among the Zambian team and the guidance of the Japanese surgeons.
Terumo supported this project by supplying, free of charge, the oxygenators and cardiovascular circuits needed for training medical professionals as well as the syringe pumps that are used after surgeries. We also provided the oxygenators and cardiovascular circuits required for the actual surgeries. Oxygenators are used to temporarily provide the functions of the lungs in cardiovascular surgeries and other surgeries that entail stopping the heart. Today, hollow fiber oxygenators*3 are commonly used. These oxygenators were first developed by Terumo. Since the initial launch of hollow fiber oxygenators in 1982, we have proceeded to implement refinements and improvements to realize more stable gas exchange performance and more compact designs, innovations that have led to Terumo hollow fiber oxygenators being used in medical settings worldwide.
Surgery in progress
Oxygenator with integrated arterial filter
TICO is continuing its efforts to cultivate Zambian surgeons to ensure that such surgeries can be performed in Zambia reliably and consistently in the future. Similarly, Terumo will keep supporting the activities of TICO through the supply of oxygenators and other initiatives with the aim of making cardiovascular surgeries more readily available in Zambia and other African countries.
Open heart surgeries are surgeries for treating heart diseases that entail making incisions into the heart of the patient. Heart-lung machines are used during these surgeries to temporarily provide the function of the heart and lungs.
Atrial septal defect is a type of congenital heart disease in which a hole is present in the muscle wall between the left and right atriums of the heart at birth. Congenital heart diseases are said to occur in one in every 100 people and atrial septal defects are estimated to represent between 7%–10% of these diseases.
Hollow fiber oxygenators are oxygenators that use hollow fiber membranes, which are equipped with gas exchange functions primarily made of microporous polypropylene materials. Oxygen is supplied to the blood flow and carbon dioxide is removed through the numerous tiny holes, which only allow for passage of gas and not blood, in these materials to sustain the life functions of the patient during surgery. (Terumo’s oxygenators currently employ a design in which oxygen gas flows through the inner channels of the hollow fiber membrane and blood flows through the outer channels.)
Comment from Tokushima International Cooperation (TICO)
Dr. Osamu Yoshida
Director, Tokushima International Cooperation (TICO)
Director, Sakura Medical Corporation
I would first like to thank Terumo for their ongoing support of our activities.
We are currently working to train cardiovascular surgery teams at University Teaching Hospital with the goal of saving as many people suffering from heart disease as possible. There are many tasks that need to be tended to if cardiovascular surgeries are to continue. These tasks include enhancing the overall capabilities of the hospital, training Zambian surgeons and perfusionists, and ensuring smooth distribution of surgical equipment within Zambia. We will be steadfast in our efforts to address these tasks. I am exceptionally grateful for the various equipment Terumo has provided, especially those that were donated to us. In January 2019, we plan to begin performing coronary angiography, and the support of Terumo will be all the more important as a result. I hope this good cooperative relationship will continue on into the future.