The 26th World Congress Of The World Society Of Cardiothoracic Surgeons (WSCTS 2016) was recently held in Cape Town, South Africa and was jointly hosted with The 17th Annual SA Heart Congress. The following provides an overview of the Programme for Rheumatic Heart Disease as part of WSCTS 2016.

WSCTS  Programme for Rheumatic Heart Disease – Cape Town

Session 1: RHD and the Heart Team
Chairs: Kalangos, Zühlke, Lawrenson

• The paediatric cardiologist and researcher (Screening for RHD) - Liesl Zühlke (South Africa)
• The cardiologist’s role in prevention and control (Secondary prevention) - Cleonice de Mota ( Brazil)
• The surgeon  (Minimally invasive surgery for RHD) - Jacques Sherman (South Africa)

This was an excellent first session focusing on the heart team and the contributions of the various disciplines in assessing and reviewing different aspects of research, clinical and surgical practice and outcomes of RHD. Liesl Zühlke covered all aspects of screening of RHD including criteria, focused protocols and long-term outcomes. She reflected on the need for screening in different populations such as adults, older children and the clear requirement for long-term studies. Cleonice De Mota from Brazil reflected on secondary prophylaxis and showed some interesting data recently published in Frontiers in Pediatrics demonstrating the effect on outcomes of a low-cost multidisciplinary approach including direct patient involvement (providing medication, transport and follow-up efforts). These data also suggested some clear prioirities for improving adherence and outcomes. The final talk in this section was from Jaques Sherman and gave fascinating data as well as excellent surgical videos on minimally invasive surgery for RHD. This technique has been used extensively in Cape Town and is a method which can be used for both repair and replacement. The data on long-term outcomes were fascinating and showed once again that replacement is not a single operation but excellent results can be achieved with both methods when patients are chosen carefully with full input throughout.

Session 2: RHD Surgery around the world:
Chairs: Sir Prof Magdi Yacoub, Prof Mario Turina

• The Global burden of Rheumatic Heart Disease - David Watkins
• Forum: Insights into RHD surgery around the world
• RHD in Algeria - Abdelmalek Bouzid (Algeria)
• Mitral valve repair in Rheumatics in the current era - Yakub Mohamed Azhari (Singapore)
• Results of valve replacement in juvenile rheumatic heart disease - Vivek Kanhere (India)
• Underlying Rheumatic Disease: An Important Determinant of Outcome in Tricuspid Valve Repair - Mandhir Munasur (South Africa)
• RHD Heart teams in the world: what still needs to be done?  - Peter Zilla

This final session had a full room, also due to the presence of one of the designated living legends of the congress- Sir Magdi Yacoub. His keen interest in all things rheumatic was evident in his astute comments, suggestions and questions. The first talk set the scene with an excellent overview of the global burden of disease from David Watkins which encapsulated not only the latest numbers but also considered the needs for new data, regionalization of data, new hot spots of disease and insights from the GBD. This talk generated much interest and questions. Following this, we had a fascinating insight into the transitional data from Algeria- no documented ARF but significant burden of RHD. The surgical expertise and units in Algeria was also of great interest to the audience. The following speaker, Dr Yakub Mohamed Azhari was from Singapore and outlined the strategies to focus on mitral valve repair in Singapore despite a large burden of severe disease with mixed mitral valve disease, calcification and commissural fusion. Dr Vivek Kanhere highlighted the huge needs around Mitral valve replacement, subsequent warfarin therapy and concerns with blocked valves. This sobering talk was delivered with much passion and the commitment of Drs Vivek Kanhere's team was evident in the presentation. Dr Mandhir Munasur from Durban, South Africa reported on an elegant study looking at tricuspid valve repair in the presence of mitral valve disease. Peter Zilla lamented on the dearth of surgical units but then reviewed local, cheaper and more innovative opportunities for valve repair and replacement. An excellent session, well-attended with wonderful speakers which generated much interest, questions, and discussion. Following the session, several audience members took the opportunity to take pictures with Sir Prof Magdi Yacoub and ask further questions. Of note was the fact that one of the speakers, Mitral valve repair in rheumatics in the current era -Yakub Mohamed Azhari (Singapore) won one of the best prizes of the conference- the Tanaka prize for furthering cardiac surgery in Africa.

This report of the WSCTS 2016 RHD Programme was provided by Dr Liesl Zühlke