A 17-Year Experience of Valvular Heart Surgery in Rwanda.
Publication Title
The Annals of thoracic surgery
Document Type
Article
Publication Date
6-21-2025
Keywords
washington; spokane
Abstract
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Surgery
DOI
10.1016/j.athoracsur.2025.06.008
