A 17-Year Experience of Valvular Heart Surgery in Rwanda

Area of Science:

• Cardiovascular Surgery
• Public Health
• Rheumatic Heart Disease Management

Background:

• Rheumatic heart disease (RHD) often presents advanced in Rwanda, requiring surgical intervention.
• Valvular heart operations are crucial for managing RHD in this population.
• This study analyzes outcomes of valvular surgery in Rwanda from 2006 to 2023.

Purpose of the Study:

• To summarize the outcomes of valvular heart operations performed in Rwanda.
• To compare the long-term survival and complications between mechanical and bioprosthetic valve replacements.
• To identify factors influencing survival after valvular surgery.

Main Methods:

• Retrospective analysis of 366 patients from the Rwandan cardiac surgery registry.
• Examination of surgical details, perioperative, and long-term outcomes.
• Multivariable Cox analyses and subgroup analyses comparing valve types.

Main Results:

• The average age at surgery was 25 years; 63.9% were female. Mitral valve surgery was most common (66.7%).
• 30-day postoperative mortality was 2.2%. All-cause mortality at long-term follow-up (average 7.8 years) was 18.2%.
• Bioprosthetic valve replacement had higher all-cause mortality (32.7%) vs. mechanical (15.6%). Complications differed: embolism/bleeding for mechanical, structural deterioration for bioprosthetic.

Conclusions:

• Low 30-day mortality indicates successful patient selection, surgery, and care.
• Mechanical valves offer superior long-term survival compared to bioprosthetic valves, primarily due to degeneration and reoperation rates.
• Enhancing postoperative follow-up and surgical complexity capacity are key areas for improvement.