During the course of 2016 and 2017 several meetings were held with the presidents and key representatives of five major cardiac societies: (1) the ‘American Association of Thoracic Surgeons (AATS); (2) the ‘Asian Society for Cardiovascular and Thoracic Surgery’ (ASCVTS); (3) the ‘European Association for Cardiothoracic Surgery (EACTS); the ‘Society for Thoracic Surgery’(STS) and the ‘World Heart Federation’ (WHF) with the proposal to establish an umbrella body representing all five in order to coordinate efforts in developing countries. With all of them present, the Cape Town Declaration was signed in 2017 and ratified by the five societies in 2018. It was published (1, 2, 3, 4, 5, 6) in the nine leading journals of our discipline. Since then, several publications followed (again co-published by the major journals) summarising the next steps. Activities have included meetings at annual conferences, exhibit hall participation for advertisement and recruitment, and publication of selection criteria for cardiac surgery centres to apply for CSIA support. Criteria focused on local operating capacity, local championing, governmental and facility support, appropriate identification of a specific gap in care, and desire to engage in future research. Eleven applications were received for which three finalist sites were selected and site visits conducted. The two selected sites are Hospital Central Maputo (Mozambique) and King Faisal Hospital Kigali (Rwanda). 

Furthermore, the steering committee of CSIA has decided to have the administrative and financial home of the CSIA at UCT. Additionally, the ‘Cardiac Surgery: Outreach Africa’ group has formalised a memorandum of understanding with Maputo Central Hospital / University for a mentoring partnership with teams from Mozambique. This has materialised in a team coming to UCT for a training course presented by Professor Justiaan Swanevelder on transoesophageal echo. This mentorship shall also include virtual ‘heart-team’ meetings to discuss problematic patients and return visits by us to help with challenging cases.