Cardiac Surgery Program at MTRH Builds Momentum
For young adults in western Kenya living with damaged heart valves, access to surgery can determine whether they return to school, support their families and plan for the future or continue living with a disease that makes each of these everyday activities difficult.
At AMPATH partner Moi Teaching and Referral Hospital in Kenya, more young patients are getting a chance to grow, and to live a happy and productive future.
Over the past several years, AMPATH partners have worked alongside MTRH clinicians to expand access to complex cardiac surgery, particularly for patients with rheumatic heart disease (RHD) and the progress has been significant. MTRH performed more cardiac surgeries than any other public facility in Kenya in 2024.
Comprehensive cardiovascular care begins with a strong cardiology program. In collaboration with AMPATH partners led by Duke University, MTRH has established a center of excellence in cardiology care including an inpatient cardiac care unit and comprehensive cardiology clinic with a significant percentage of patients having RHD.
“These are often patients in their 20s and 30s who have the rest of their lives ahead of them,” said Emily Farkas, MD, associate director of global health in surgery at Indiana University School of Medicine. “It has been incredibly meaningful to see what the MTRH team has built and how much more the program is now able to offer to patients.” Thirty-four people were treated (surgically) over the last few months and the average age at diagnosis was just over 25-years-old.
The cardiac surgery partnership began taking shape in 2018 and expanded in 2022, bringing together clinicians from MTRH, Moi University, Kenyatta National Hospital, Indiana University, and the University of Texas at Austin. Following integral seed funding from the Edwards Lifesciences Foundation and the Thoracic Surgery Foundation, the Michael & Susan Dell Foundation has supported the surgical program in 2025 and 2026.
One of the clearest signs of progress is in the operating room.
Periodic surgical training visits from AMPATH’s U.S. partners are designed to do more than provide care for surgical patients. With each case, MTRH clinicians take on greater responsibility. Clinical protocols to guide decision-making and surgical judgment and perioperative care have been developed and implemented.
“With every case, our team is gaining the experience and confidence to take on more,” said Stephen Ondigo, MBChB, MMed, chief of cardiothoracic surgery at MTRH. “That means building a program that can be here for patients not just during a surgical team visit from our AMPATH partners, but throughout the year.”
Just as important is what has changed outside the operating room.
New echocardiography equipment is improving cardiac imaging and a new image archiving system allows clinicians to save and review echocardiograms, making it easier to plan surgery and monitor patients afterward.
A multidisciplinary cardiac team brings specialists together to make decisions about each patient’s care. The MTRH structural heart disease registry is also being strengthened to track risk factors, treatment, outcomes and follow-up. Those data are beginning to show what years of investment in the program have accomplished.
“We are starting to see a steady improvement,” said Gedion Titus Ngeno, MD. “As there is more engagement, teaching and sharing, complication rates are lower and outcomes are better. We can use one-year and five-year survival information to keep improving.”
But progress has also revealed where challenges still remain.
Lack of disease awareness and limited diagnostic capacity, including shortages of trained sonographers, can delay the identification and referral of patients with advanced valvular heart disease. Staffing and supply chain issues can disrupt care. Competing demands for operating room time, anesthesia coverage, and intensive care beds further constrain access to timely treatment. In addition, limited capacity for anticoagulation management and long-term follow-up, increases the risk of complications after surgery. While the surgical training visit model has expanded access to life-saving care, continued investment in local surgical services, anticoagulation management, rehabilitation and longitudinal follow-up will be essential to ensure that patients not only reach surgery in time but also achieve sustained recovery and return to productive lives.
“During my residency at MTRH, I recall helplessly watching heart patients like this die. Now, we have learned a tremendous amount about what it takes to move a patient all the way from diagnosis through surgery and recovery,” said Joan Kiyeng, MD, MMed, CFell Cardiology, an MTRH cardiologist and graduate of the Moi University cardiology fellowship. “When we identify a bottleneck, whether it is imaging, referral or follow-up, we have an opportunity to strengthen that part of the system.”
Partners are now working to address those gaps by strengthening referrals from health facilities across the region, expanding training and moving toward more consistent, year-round cardiac surgery. Efforts are underway to strengthen patient education and follow-up including development of cardiac rehabilitation capacity, to help people seek care earlier and stay connected to treatment.
The ambitions extend further. Once a regular cadence of surgery for rheumatic valve disease is established, the team hopes to expand into coronary surgery to complement MTRH’s new catheterization laboratory and eventually add pediatric cardiac surgery.
For Dr. Farkas, those goals reflect how far the program has come and what is now within reach.
“The MTRH team has really excelled and advanced what can be offered to the community,” she said. “Now we have the opportunity to build on that progress so more patients can get the care they need, when they need it, closer to home.”