The Future of Cardiac Surgery in Morocco: What We Still Need

Through direct observation across Morocco's public and private healthcare facilities over several years, I have tracked the development of cardiac surgery in our country. Cardiovascular disease accounts for approximately 38% of national mortality. This review evaluates current cardiac surgery capabilities, drawing on frontline insights, and identifies key requirements for future enhancement.

Understanding the Burden on the Heart

The heart serves as the body's primary pump, circulating oxygenated blood to vital organs. Blockages in coronary arteries or valve defects disrupt this flow, resulting in ischemia, heart failure, or rhythm disturbances. In practice, patients often present with acute symptoms—a middle-aged individual with unmanaged hypertension experiencing chest discomfort. Timely lifestyle adjustments or pharmacotherapy can prevent escalation to surgery, though many cases advance to operative intervention.

The financial toll is considerable: ischemic heart disease generates costs surpassing $1.2 billion annually, equivalent to nearly 1% of GDP. Efficient surgical management extends lifespan and lowers overall expenditure via reduced hospitalization and complications.

Current Achievements in Moroccan Cardiac Surgery

Morocco operates around 11 dedicated centers for open-heart operations, mainly in Casablanca, Rabat, and Marrakech. In 2023, the first domestic implantation of a Heart-Mate 3 left ventricular assist device occurred in Casablanca, providing critical support for a 68-year-old with advanced heart failure and serving as a bridge to transplantation.

Early 2025 marked another advance with the initial minimally invasive tricuspid valve repair at Ibn Sina University Hospital in Rabat. Elective procedure mortality aligns with global standards at 1-2% for low-risk profiles. Partial sternotomy approaches have shortened recovery periods significantly.

Identified Gaps from System Observation

Progress remains inconsistent. In peripheral facilities, logistical issues like power interruptions or blood supply shortages routinely delay operations. Patients from rural areas frequently endure long journeys, arriving in deteriorated condition.

Human Resource Constraints

Specialist density is limited, with under 50 cardiothoracic surgeons countrywide. Training pathways in university settings face case volume restrictions; mastery of minimally invasive methods demands 75-125 supervised procedures. Talented trainees often seek opportunities abroad.

Financial and Accessibility Barriers

Bypass grafting costs can surpass 50,000 MAD out-of-pocket, unaffordable for most without robust insurance. AMO expansions aid access, but advanced procedure coverage remains incomplete. Delayed primary care referrals, stemming from limited diagnostic tools in outlying clinics, worsen prognosis.

• Urban concentration: 70% of interventions in major cities.
• Growing risks: Obesity at 22%, diabetes at 11%.
• Logistical delays: Prosthetics affected by import chains.

Emerging Technologies and Opportunities

Robotic systems are in pilot phases at select private institutions, enabling precise repairs through minimal incisions. Telemedicine could facilitate remote consultations, linking remote providers with experts. AI-driven ECG analysis is being tested for early risk identification in basic settings.

Pediatric cases demand attention; 4,000-5,000 children need corrections yearly, with current capacity insufficient. Mobile detection programs, as implemented in Fes, prove effective for timely identification.

Strategic Priorities for Advancement

Resolution necessitates integrated efforts in policy, training, and infrastructure.

Priority Area	Rationale	Proposed Action
Workforce Development	Low specialist numbers constrain volume	Launch 3-year programs with 100 slots annually
Infrastructure Expansion	Geographic gaps postpone treatment	Equip hybrid units in 4 regions by 2030
Financial Reform	Costs limit patient access	Ensure full coverage for core procedures
Prevention Integration	Lowers overall surgical load	Implement nationwide blood pressure checks

Collaborations with bodies like the European Society of Cardiology can expedite knowledge and resource sharing.

Conclusion

Morocco demonstrates proficiency in sophisticated cardiac interventions, but deficits in personnel, equity, and resources hinder broad impact. Observations from within the system highlight the necessity for targeted investments in training, decentralized facilities, and upstream prevention. Aligning on these fronts will shift cardiac care from crisis response to proactive management, improving outcomes across the population.