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Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire
Koffi Herve Yangni-Angate1, Christophe Meneas1, Florent Diby1
1Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire.
Insights
Open heart surgery (OHS) in Sub-Saharan Africa successfully treated rheumatic heart disease, endomyocardial fibrosis, and congenital heart defects. This study highlights the feasibility and outcomes of OHS in the region.
Area of Science:
- Cardiovascular Surgery
- Public Health
- African Medicine
Background:
- Limited centers for open heart surgery (OHS) exist in Sub-Saharan Africa.
- There is a notable lack of reported OHS outcomes from the region.
- This study addresses this gap by presenting African OHS experience.
Purpose of the Study:
- To report the experience and outcomes of open heart surgery (OHS) in Cote d'Ivoire.
- To describe the spectrum of heart diseases treated surgically in an African setting.
- To contribute data on OHS to the under-documented Sub-Saharan African region.
Main Methods:
- A retrospective study of 2,612 patients undergoing OHS between 1978 and 2013.
- Data collection included demographical, clinical, investigative, surgical, and outcomes parameters.
- Analysis focused on rheumatic heart diseases (RHD), endomyocardial fibrosis (EMF), and congenital heart diseases (CHDs).
Main Results:
- 1,475 RHD cases included 1,175 valvular surgeries with 7% global mortality.
- 126 EMF cases underwent surgery, with 16% hospital mortality.
- 741 CHDs, including VSD and ASD, had 6.4% early mortality after total correction.
Conclusions:
- Open heart surgery in Cote d'Ivoire was successfully performed across various cardiac conditions.
- The spectrum of acquired valvular heart diseases and CHDs aligns with that seen in other Sub-Saharan African countries.
- This experience demonstrates the successful application of OHS in an African context.
Background:
Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap.
Methods:
It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters.
Results:
There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44).
Conclusions:
OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.
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