Mid-term outcomes after open-heart surgery for severe chronic rheumatic heart disease in a low-income country: an observational study with historical controls

Objectives The literature is sparse regarding outcomes after valvular surgery in patients with severe chronic rheumatic heart disease (RHD) in low- and middle-income countries (LMICs). We aimed to evaluate mid-term outcomes in patients with severe chronic RHD who underwent open-heart surgery in Ethiopia, and evaluate the durability of the operated valves during follow-up. Methods This study implemented an observational design, with 104 patients screened for cardiac surgery, of whom 52 were excluded. Outcome measures and clinical and echocardiographic data after cardiac surgery were available for the remaining 52 patients. Survival was compared with that of a cohort of 157 control patients recruited from the waiting list based on similar characteristics. Of these patients, 108 were lost to follow-up or underwent surgery or interventions performed by other missions, leaving 49 for comparison. The functioning of the repaired valves or valvular prosthesis was examined by echocardiography. Results The mean follow-up time among the 52 (65% women) surgical patients and 49 (76% women) controls was 4.1 years and 3.6 years, respectively. In the surgical group, 46 (88%), 25 (48%), and 18 (35%) patients underwent mitral, tricuspid, and aortic valve surgeries, respectively. The survival rate at last follow-up was 83% in the surgical group and 57% in the control group ( P = 0.004). At their last follow-up, four patients had moderate valvular obstruction and none had severe valvular dysfunction. Conclusions Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is well-structured and can improve survival at mid-term follow-up. The durability of both repaired and replaced valves was good.