SA Heart Journal

Temporal trends of transcatheter aortic valve implantation practice in South Africa

T Mwase — 2026-05-08

Background: The temporal trends in transcatheter aortic valve implantation (TAVI) practice and procedural benefits are well documented in high-income countries; however, data for upper-middle-income countries (UMIC) are sparse.

Objectives: This study aimed to describe the evolution of TAVI practice in South Africa, including patient and procedural characteristic profiles and outcomes, from 1 September 2014 to 31 December 2023.

Methods: The South African Heart Association (SHARE)-TAVI registry is a web-based, all-comers prospective registry. The 18 centres that were involved from the outset of the registry in September 2014 were included in our analysis.

Results: A total of 2 532 TAVIs were performed across the 18 centres. There was a steady increase in TAVI procedures, with most performed in private hospitals (n = 2 251). Waiting times were shorter in the private hospitals, with a median of 52 days (interquartile range [IQR] 29–82), compared with public hospitals, with a median of 70 days (IQR 61–85). Over time, the median age remained stable at 81 years (IQR 75–85). The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II showed a continuous and significant decline from 4.9% (IQR 4.4, 8.6) in 2014/15 to 3.5% (1.9, 6) in 2023 (p < 0.001). Transfemoral access was the most prevalent access route utilised throughout the study period, and there was a trend of increased use of percutaneous closure devices with lower vascular complications (11% in 2014/15 to 5% in 2023; p < 0.001). There was also a notable reduction in periprocedural strokes (10% in 2014/15 to 2% in 2023; p < 0.0001). Kaplan-Meier survival curves showed a gradual decrease in mortality risk (p = 0.0344). Accordingly, the 1-year mortality fell from 17% in 2014/15 to 6% in 2022 (p < 0.001).

Conclusion: This data showed a steady increase in the number of TAVI procedures during the study period, with a reduction in risk profiles despite the mean age remaining stable, consistent with international recommendations. Technical aspects of the procedures evolved and were associated with reduced complications.

Characteristics and outcomes of patients hospitalised with acute heart failure at a tertiary hospital in South Africa

A Mazaza — 2026-05-08

Aims: Acute heart failure (AHF) remains a major public health challenge in sub-Saharan Africa, yet contemporary data on its clinical characteristics and management outcomes are limited. This study aims to characterise the epidemiology, treatment patterns, and clinical outcomes of AHF patients in a South African tertiary care setting in the era of modern heart failure (HF) therapy.

Methods: We conducted a retrospective study of 339 AHF admissions at Tygerberg Hospital (TBH), Cape Town, during 2022. Comprehensive data, including demographics, clinical characteristics, investigations (echocardiography, coronary angiography), treatment regimens, and outcomes, were analysed. Patients were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes for HF and cardiomyopathy.

Results: The cohort (mean age 53 ± 15.4 years, 51.9% male) demonstrated a high burden of non-ischaemic cardiomyopathy with HF with reduced ejection fraction (HFrEF) predominance (91%). Comorbidities were highly prevalent (74% hypertension, 43.4% diabetes). While conventional guideline-directed medical therapy (GDMT) utilisation was robust (88.7% beta blocker [BB], 87.5% angiotensin-converting enzyme inhibitor [ACEi]/ angiotensin receptor blocker [ARB]), novel therapies were markedly underutilised (3.9% sodium-glucose cotransporter 2 inhibitor [SGLT2i], 1.3% angiotensin receptor-neprilysin inhibitor [ARNi]). Only 42.9% of eligible patients for cardiac resynchronisation therapy (CRT) received implants. Clinical outcomes included rates of 3.9% in-hospital mortality, 27.7% 2-year case fatality, and 44.3% 30-day re-admission.

Conclusions: This study reveals a distinct AHF phenotype in South Africa, characterised by younger patients with a predominant non-ischaemic aetiology and high comorbidity burden. Despite adequate conventional GDMT implementation, significant therapeutic gaps persist in advanced therapies. The substantial re-admission burden highlights critical health system challenges, emphasising the urgent need for healthcare policy reforms and optimised care pathways in resource-limited settings.

Cardiac catheterisation laboratory procedures and in-hospital outcomes at a tertiary facility: A 1-year review from Groote Schuur Hospital, Cape Town, South Africa

B Beyers — 2026-05-08

Background: Cardiovascular disease (CVD) is the leading cause of death in South Africa; however, comprehensive data on public-sector cardiac catheterisation laboratory (cath lab) procedural patterns and outcomes remain scarce.

Methods: We conducted a retrospective observational study using the Groote Schuur Hospital Cardiac Catheterisation (GSH-CATH) registry at Groote Schuur Hospital (GSH), Cape Town, South Africa, analysing all adult patients undergoing non-electrophysiology procedures between December 2022 and November 2023.

Results: A total of 1 694 procedures were performed in 1 239 patients (median age of 58 years, 60.5% female). The primary indications were acute coronary syndrome (ACS) (56.7%) and valvular heart disease (17.7%), with diagnostic coronary angiography (DCA) (40.9%), DCA with percutaneous coronary intervention (PCI), or PCI only (26.0%) being the most frequent procedures. Cardiovascular risk factors were highly prevalent, including hypertension (65.4%), smoking (44.1%), and diabetes (32.5%). The overall procedural complication rate was 6.5%, primarily driven by access-site events (3.2%). Intra-procedural and in-hospital mortality rates were 0.3% and 3.6%, respectively. Systemic hypertension was significantly associated with procedural complications (p = 0.03).

Conclusion: This study provides the first comprehensive evaluation of cath lab activity at a South African tertiary facility, highlighting high procedural volume and a unique female-dominant demographic, despite a high proportion of patients requiring emergency or time-sensitive interventions. These findings establish a baseline for quality improvement and resource allocation in the South African public health sector.

ECG Quiz 72

Rob Scott Millar — 2026-05-08

ECG Quiz 72

ECG Quiz 72 Answers

Rob Scott Millar — 2026-05-08

ECG Quiz 71 Answers

Traditional statistics versus machine learning in clinical registries: A pragmatic workflow for matching methods to data and clinical questions

A Wentzel — 2026-05-08

This piece discusses the importance of data type, identification, and organisation for machine learning (ML) and neural network (NN) development, and the applicability of ML for statistical analysis in large clinical and physiological datasets, such as the South African Heart Association Registry (SHARE).

Core outcomes/key lessons

To enable clinicians and researchers to:

Systematically assess their clinical dataset (registry data, e.g. SHARE) for variable types, dimensionality, sample size, missingness, and event rates.
Understand when traditional statistical methods are sufficient, when regularised regression is preferable, and when more complex ML approaches are justified.
Recognise common pitfalls (overfitting, multicollinearity, data leakage, mis-specified outcomes), and how to avoid them in both “classic” and ML settings.
Apply a staged workflow to their own data, using the SHARE-transcatheter aortic valve implantation (TAVI) registry as an illustrative case.

SASCI-Mayo Clinic Fellows webinar: Vein graft interventions

E Nel — 2026-05-08

This publication is the third instalment in a series of webinars conducted jointly by the South African Society of Cardiovascular Intervention (SASCI) and Mayo Clinic. Hosted by the regular faculty, the webinar began with an in-depth analysis of the pathogenesis of vein graft disease by Dr Barsness. It included a critical appraisal of published data supporting various interventional strategies in this patient population. His presentation was followed by a clinical case study by Dr Engelbrecht, focusing on a patient with recurrent acute coronary syndrome (ACS) events due to vein graft disease. Cardiology fellows from various South African universities participated as discussants.

Objective: This manuscript, derived from the webinar series, summarises a multidisciplinary discussion of vein graft intervention complexities. It addresses the underlying pathophysiology, technical considerations, and current evidence- based management strategies.

Case summary: A male patient with prior coronary artery bypass grafting (CABG) presented with recurrent episodes of ACS secondary to progressive vein graft disease. The discussion explored the pathogenesis of vein graft disease and the technical challenges of intervention, with a specific focus on the evidence and clinical considerations when deciding between vein graft and native vessel revascularisation. Following recurrent ACS events and percutaneous coronary intervention (PCI) attempts in the diseased vein graft, the patient eventually achieved successful revascularisation through a chronic total occlusion (CTO) procedure in the native left anterior descending artery (LAD).

Cardiac Imaging Quiz

R Meel — 2026-05-08

What is the diagnosis?

Mitral stenosis with thrombus
Atrial Myxoma
Infective endocarditis
Metastatic tumor

South African Heart Association Position Statement for the management of valvular heart disease – Part I

R Meel — 2026-05-08

The burden of valvular heart disease (VHD) remains high in South Africa and is associated with considerable morbidity and mortality. While a decline in acute rheumatic fever cases has been observed, chronic rheumatic VHD remains an important cause of index heart failure admission in South Africa. Additionally, with the increased longevity of the African population, degenerative VHD has emerged as an important aetiology. To date, data about VHD epidemiology, diagnosis, management, and patient follow-up remain scarce in this region. Patients with VHD and their physicians face unique challenges in the South African setting. Hence, in this Position Statement, we aim to provide the general cardiologist with a comprehensive review to complement existing guidelines on VHD for adequate patient management in the local setting. This document will comprise 2 parts. Part I focuses on the evaluation and management of native VHD. Part II will focus on prosthetic heart valves, infective endocarditis (IE), preoperative assessment of patients with VHD, VHD considerations in children, and future directions.

Cardiac surgery in South Africa: Have we failed our legacy?

D Reddy — 2026-05-08

Cardiac surgery in South Africa (SA) was thrust onto the world stage in 1967 following Christiaan Barnard’s world-first orthotopic heart transplant in Cape Town. This pioneering achievement defined the country as an unlikely leader in daring surgical innovation, clinical excellence and laboratory research.⁽¹⁾ The decades following the first heart transplant launched the speciality on a pathway of surgical excellence, evident by world-class surgeon-leaders and internationally renowned training units.

That stellar trajectory has unfortunately reversed, and the current SA cardiac surgery landscape is characterised by the lack of experienced academic leadership, virtually non-existent training and surgical programmes, and the lack of outcomes reporting and benchmarking in both private and public sectors.

Rethinking cardiac surgical care in South Africa: A call for a dialogue

Ruchika Meel — 2026-05-08

The editorial titled “Cardiac surgery in South Africa: Have we failed our legacy?” By Reddy et al. discusses the temporal transition of cardiothoracic surgery in South Africa.⁽¹⁾ Cardiothoracic surgery in South Africa has a strong international legacy, highlighted by the world’s first heart transplant in 1967. However, at present services are unevenly distributed, with most specialists and resources concentrated in urban private hospitals, while the public sector faces long waiting lists and limited capacity. Chris Hani Baragwanath Academic Hospital (CHBAH), the third largest hospital in the world, currently lacks onsite cardiothoracic surgical services and has not performed cardiac surgery for nearly 30 years.⁽²⁾ All surgical cases are referred to the overburdened and under-resourced Charlotte Maxeke Johannesburg Academic Hospital.⁽²⁾