Open-Heart Surgery at the Lagos State University Teaching Hospital (LASUTH) commenced in 2004. Early years were based on a Cardiac Mission Model, but since 2017 the focus was on the transition to a Local Team Model with autonomous Open-Heart Surgery. The aim of this study is to describe our progress in making this transition, highlight lessons learned, and detail the outstanding challenges to be overcome. This study is a retrospective analysis of prospectively maintained data from the LASUTH cardiothoracic database and Nigeria Open-Heart Surgery Registry between November 2004 and December 2021. Data extracted included patient demographics, EuroSCORE II, operative procedure, operative category, lead surgeon, complications, and outcomes. Over the study period, 100 operations were done over 2 time periods, 51 operations between 2004 – 2011 (Cardiac Mission Period) and 49 operations between 2017 – 2021 (Transition Period). In the Cardiac Mission Period, 21.6% of the operations were done by the Local Team and in the Transition Period this increased to 85.7% of the operations completed. Overall mortality was 14%, dropping from 17.6% in the Cardiac Mission Period to 10.2% in the Transition Period. The Local Team is now gradually taking on more diverse cases while striving to maintain good outcomes. Our institution has successfully made the transition from Cardiac Missions to Autonomous Open-Heart Surgery without an increase in mortality and a gradual increase in surgical volumes. Lessons learned included a strategy to focus on adult surgery, avoidance of high-risk cases, and moving from free surgery toward an appropriate cost structure for program sustainability. Contributory factors to the successful transition include the active support of the hospital management (provision of appropriate infrastructure and equipment, investment in training of the Local Team), continued humanitarian international collaborations focused on skill transfer, and maintenance of Local Team skills by collaborations with other active cardiac centers in Nigeria. Remaining challenges include financing to bridge equipment gaps, maintenance and replacement of equipment as well as the evolution of a national health insurance schema that would ideally support Open-Heart surgery for Nigerian patients. Until that time, patients & programs must rely on supplemental funding of surgery to increase surgical volumes.

拉各斯州立大学教学医院 (LASUTH) 于 2004 年开始开展心脏直视手术。早期以心脏任务模型为基础，但自 2017 年以来，重点转向采用自主心脏直视手术的本地团队模型。本研究的目的是描述我们在实现这一转变方面取得的进展，强调经验教训，并详细说明需要克服的突出挑战。本研究对 2004 年 11 月至 2021 年 12 月期间 LASUTH 心胸数据库和尼日利亚心脏直视手术登记处的前瞻性维护数据进行回顾性分析。提取的数据包括患者人口统计数据、EuroSCORE II、手术程序、手术类别、主刀医生、并发症和结果。在研究期间，共在 2 个时间段内完成了 100 例手术，其中 2004 年至 2011 年（心脏任务期）期间进行了 51 例手术，2017 年至 2021 年（过渡期）期间进行了 49 例手术。在心脏任务期间，21.6% 的手术由当地团队完成，而在过渡期间，这一比例增加到已完成手术的 85.7%。总体死亡率为 14%，从心脏任务期的 17.6% 降至过渡期的 10.2%。目前，当地团队正在逐步受理更多样的案件，同时努力保持良好的结果。我们的机构成功地从心脏任务过渡到自主心内直视手术，死亡率没有增加，手术量也没有逐渐增加。吸取的经验教训包括专注于成人手术、避免高风险病例以及从免费手术转向适当的成本结构以实现项目可持续性的策略。成功过渡的促成因素包括医院管理层的积极支持（提供适当的基础设施和设备、对当地团队的培训进行投资）、持续开展以技能转让为重点的人道主义国际合作，以及通过与其他机构合作来维持当地团队的技能。尼日利亚活跃的心脏中心。剩下的挑战包括弥补设备缺口的融资、设备的维护和更换以及国家健康保险计划的演变，该计划将理想地支持尼日利亚患者的心脏直视手术。在那之前，患者和项目必须依靠手术的补充资金来增加手术量。