Vietnam, a vibrant country of 82 million people in Southeast Asia, has made significant strides in the political and economic sectors since reunification under a socialistic government in 1975. Health care spending is less than five percent of GDP and remains socialized with small attempts to privatize. The development and growth of cardiac surgery has accelerated since 1992 with the opening of the Carpentier Heart institute in Ho Chi Min City (formerly Saigon). At present there are 10 centers performing cardiac surgery in Vietnam (6 in Hanoi; 2 in Ho Chi Min City; 1 in Haiphong; and another in Hue; 2 more centers in Ho Chi Min City and one in DaNang are scheduled to open soon). Over 30 cardiac surgeons perform over 2,500 procedures annually in Vietnam. Eighty percent of the caseload is valve and congenital heart operations. Coronary artery disease, which is increasing dramatically, is treated primarily with angioplasty/stenting. Interestingly, each stent costs around $1,000 US. There is a basic 3 year cardiac surgery training program in Hanoi and Ho Chi Min City, but the majority of surgeons have received formal and additional training in France, Australia, and Korea. English and French are widely spoken. The average “out of pocket” cost for heart surgery in Hanoi is $1,500-2,000 for congenital heart disease and $2,000-4,000 for valve surgery (average prosthetic mechanical valve costs under $1,000). A short term government program has allowed free open heart surgery for children less than 6 years of age with congenital heart disease. In Hanoi, cardiac surgeons are employed by the central or local government with a monthly salary ranging from $200 to $400.
A number of individual surgeons and teams have been engaged with projects in Vietnam over the past 14 years. Alain Carpentier made the greatest impact on cardiac surgery with the Cardiac Institute in Ho Chi Min City. Presently over 1,200 cases are performed there annually, with Dr. Nguyen Van Phan developing an international reputation with his aggressive approach and gratifying results with complex rheumatic valve repair. Viet Duc hospital in Hanoi, the major surgical training program in north Vietnam, performs over 800 open-heart operations annually. Dr. Dang Han De, the recently retired chief of cardiac surgery at Viet Duc Hospital, has done a monumental job in keeping cardiac surgery alive during the “lean years” from 1968 to 1994. Dr. Le Ngoc Thanh, his successor, continues this work, implementing, in a practical and phased way, difficult operations for congenital heart disease, both in terms of decreasing weight limits and complexity.
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Rheumatic fever and rheumatic heart disease, though still prevalent, is decreasing. Yet the incidence of congenital heart disease remains constant, and coronary artery disease is increasing, as noted. The challenges facing cardiac surgery in Vietnam include: increased governmental funding for cardiac services; continued improvements in sophisticated or more advanced surgical techniques; the establishment of both clinical and basic research/development initiatives and the slow emergence of private practice initiatives. For information regarding volunteer opportunities for solo or group efforts please contact Thomas Pezzella MD (tpezzella@hotmail.com ). The Children's Hospital in Hanoi, as well as Viet Duc hospital would welcome a sustained collaborative relationship with a dedicated NGO or medical center cardiac surgery team, particularly in pediatric cardiac surgery.
