From Numbers to Lives: How International Collaboration is Saving Children’s Hearts in Brazil

Two medical professionals performing surgery on infant in hospital. When a child needs surgery for their heart condition, the quality and safety of care before, during and after can mean the difference between life and death. At one of Brazil’s leading hospitals, an estimated 8 in every 100 children undergoing heart surgery in 2020 didn’t survive. For families, those statistics represent something deeply personal: a son, a first grandbaby, a future filled with hope.

The future is changing. That same stat looks different today—3 in every 100.

A study published in the Brazilian Journal of Cardiovascular Surgery found that by driving improvements in quality and safety, more children born with congenital heart disease are surviving.

“This study demonstrates that a well-structured, long-term international collaboration can generate measurable and meaningful clinical impact in a resource-constrained setting. This is important because it shows that major improvements do not always require major new investments. With the support of Children’s HeartLink, we were able to save more lives and use resources more efficiently, even while caring for more complex patients.”

—Dr. Leonardo Miana, pediatric cardiac surgeon at Instituto do Coração

Creating better outcomes for more children with heart disease

Medical professionals in a large classroom looking at screen with video of heart being sewn. The study reveals more children survived as the result of an investment in Quality and Safety at the hospital. After looking at data from January 2016 – May 2024, breaking it into two time periods, PRE (January 2016 – December 2019) and POST (January 2020 – May 2024), the findings were striking—outcomes improved across every key indicator:

More children survived heart surgeries. The mortality rate went from 7.5% to 5.1% before reaching 3.1% in 2024.
Elective procedures became far safer, cutting deaths by more than half.
Urgent surgeries saw a major breakthrough, as mortality fell by 42%, from 16.5% to 9.6%.
Survival rates for the tiniest patients—newborns and infants—doubled.
Hospital stays shortened, easing the emotional and financial burden on families.

These improvements happened while the pediatric cardiac care team continued to increase the complexity of their cases.

The study notes that these improvements happened faster and more dramatically than similar efforts in other countries. The reason? A proven Children’s HeartLink model: train-the-trainer partnerships, structured protocols and a culture of safety supported by local leadership and global expertise.

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Long-Term Partnerships are Paving the Way for Quality and Safety

Children’s HeartLink began a partnership with Instituto do Coração (InCor) in São Paulo and The Hospital for Sick Children (SickKids) in Toronto in 2018. InCor, one of Latin America’s leading heart centers and home to Brazil’s largest pediatric surgical program, partnered with us to change the odds for children born with heart conditions.

Children’s HeartLink partnerships are not quick fixes—they are long-term collaborations focused on hands-on training, multidisciplinary teamwork and building sustainable systems to improve care for generations to come.

“This study proves that our model saves lives. Behind every percentage point of reduced mortality is a child who gets to go home, a family spared unimaginable loss. By investing in long-term training and empowering of local healthcare teams and fostering a culture of continuous improvement, we’re building their confidence in creating systems and processes that aren’t just reducing deaths and infections, but are transforming heart care.”

— Jackie Boucher, President, Children’s HeartLink

Through the Children’s HeartLink partnership, Incor implemented structured Quality and Safety initiatives, that included:

Collaborative Pre-Surgery Planning: Multidisciplinary case conferences ensured every child’s surgical plan was reviewed by the full team, improving decision-making and timing.
Putting the Right Skills on the Right Cases: Surgical assignments were based on performance data, matching complex cases with the most experienced surgeons to boost survival rates.
Standardized Protocols and Continuous Monitoring: New care plans and post-surgery surveillance reduced complications and infections, creating consistency across all stages of care.
Culture of Accountability and Learning: Intensive Care Unit (ICU) leadership changes, weekly performance rounds and monthly morbidity meetings fostered a safety-first mindset and ongoing improvement.

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“Sustained long-term partnerships are essential because meaningful improvement in complex healthcare systems requires continuity, trust, and repeated engagement over time. This is especially important in congenital cardiac care, where outcomes depend on the performance of the entire multidisciplinary system. The long-term commitment of Children’s HeartLink, together with the Toronto SickKids team, allowed recommendations to evolve into real and lasting improvements.”

—Dr. Leonardo Miana, pediatric cardiac surgeon at Instituto do Coração

Addressing the challenge of pediatric heart care

The challenge for providing pediatric and congenital heart surgery in LMICs is complex for a number of reasons. There is limited equipment available, a shortage of trained specialists and a fragile infrastructure that leads to higher complications and mortality.

Children’s HeartLink works with hospital teams to address the limitations they can and work within the limitations they must.

Three medical professionals deep in discussion while one points to a laptop screen in a hospital office.

Scaling partnerships and results like this one is only possible because of people like you. Your support sustains the training, systems, and mentoring that make heart surgery safer for more children. Together, we can ensure more children born with congenital heart disease survive and thrive.

Donate now to help train more heart care teams and transform lives

The Children’s HeartLink Model

Children’s HeartLink leads partnerships between more than 20 hospitals in low- and middle-income countries and medical volunteers from top teaching and research institutions. These multi-year partnerships focus on upskilling team members, building capacity and strengthening multidisciplinary approaches to pediatric cardiac care.

When local hospitals achieve milestones in clinical quality, organizational systems, patient-centered care, and teaching, they become a Children’s HeartLink Center of Excellence.

Where We Work

Why This Work Matters

Congenital heart disease is the leading cause of infant death from birth defects and the largest noncommunicable disease cause of death in people under age 30.

1 in 100 infants are born with congenital heart disease
1 in 4 children with congenital heart disease need surgery in the first year of life to survive
90% of children have no reliable access to pediatric heart care

Vietnam-Nhi-Dong-1-Center-of-Excellence-Ceremony

How We Work

The Children’s HeartLink capacity building model leverages a collaborative train-the-trainer approach as the fastest and most sustainable way to treat the most children.

We also advocate globally with decision-makers to ensure all children with childhood-onset heart disease have access to high-quality and affordable pediatric heart care.

Screenshot of the study, "A Population-Based Approach to Congenital Heart Disease in Kerala, India" against a colorful backdrop.

The Results

As this InCor study demonstrates, through the Children’s HeartLink model, the mortality rate decreased from from 7.5% to 5.1% before reaching 3.1% in 2024.

This effectiveness in saving lives is also demonstrated in other studies about our work, such as the Implementation of a Population Health Program for Congenital Heart Disease in Kerala, India.

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