Objectives:
Although many patients with congenital and adult heart diseases are tracked in Europe and North America, most live elsewhere. We examined unique risk factors and comorbidities of populations in nations with disadvantaged healthcare systems to track related diseases, functional status, quality of life, morbidity, short and long-term mortality, outcome and uniformity of surgical performance.

Methods:
We constructed a database with elements and their definitions leveraged from available databases for cardiology, surgery, anesthesia and perfusion to ensure international comparisons and benchmarking. Additional elements capture the socioeconomic conditions of healthcare in the developing world and their impact on congenital cardiac care; 325 questions, adjudicated by expert consensus, focus on culture-specific demographics, socioeconomic status, quality of life and nutritional status.

Results:
Now available in English & Spanish, (www.cardiostart.org) this comprehensive database examines most aspects of perioperative care and long term follow up. It is compatible with the European Association of Cardiothoracic Surgery and Society of Thoracic Surgeons' Congenital Heart Databases, and provides a quality improvement and educational tool for evolving cardiac surgery programs in developing nations.

Conclusion:
Although mature databases exist for the collection of congenital cardiac surgical data in the developed world, these databases do not capture many of the unique qualities of disadvantaged health care systems. With this new database, medical standards which drive decision making, trends in poor community disease processes, the influence of family and cultural settings, cost-benefit of equipment and personnel, and the outcomes of local and visiting surgical teams can now be more fully examined.