A 17-Year Experience of Valvular Heart Surgery in Rwanda

The advanced presentation of rheumatic heart disease in Rwanda often necessitates surgical intervention. We summarize the outcomes of valvular heart operations in Rwanda between 2006 and 2023.

The study included 366 patients in the Rwandan cardiac surgery registry who underwent valvular surgery. We examined surgical details, perioperative outcomes, and long-term outcomes. Cox multivariable analyses were conducted to assess factors predictive of survival outcomes. Additionally, subgroup analyses compared outcomes between mechanical valve replacement and bioprosthetic valve replacement.

The average age at surgery was 25.0 (SD, 10.2 years), with 63.9% of patients being female. Mitral valve surgery, alone (45.9%) or in conjunction with tricuspid valve surgery (20.8%), was the most common procedure (66.7%). The 30-day postoperative mortality rate was 2.2%. Over an average follow-up of 7.8 years (SD, 4.5 years), the all-cause mortality rate was 18.2%. Patients who received a bioprosthetic valve replacement had a higher all-cause mortality rate than those who received a mechanical valve replacement (32.7% vs 15.6%, P = .008). The most common long-term complications for mechanical valve patients were embolism and bleeding (13.0%) compared with structural valve deterioration (26.5%) in bioprosthetic valve patients.

The low 30-day mortality rate reflects success in careful patient selection, meticulous surgery, and dedicated perioperative care. Mechanical valve replacement demonstrated superior long-term survival over bioprosthetic valve replacement mainly due to valve degeneration and need for reoperation in bioprosthetic valve patients. Key areas of improvement include strengthening postoperative follow-up and capacity for increased surgical complexity.