ABSTRACT
Background: The leading global contributor to cardiovascular morbidity and mortality is valvular heart disease. It is on the rise worldwide, including in the developing countries. However, the prevalence, patterns, and etiologies of valvular heart disease have not been well studied in Ethiopia. Hence, the purpose of this study was to evaluate the prevalence, patterns, and etiologies of valvular heart disease at the Cardiac Center of Ethiopia from February 2000 to April 2022. Methods: This institution-based retrospective cross-sectional study was conducted between February 2000 and April 2022. Data from three thousand two hundred fifty-seven VHD were extracted from the electronic medical records and analyzed using SPSS version 25. Descriptive statistics, such as the frequency, mean ± standard deviation, and cross tabulations, were used to summarize the data. Results: Of 10,588 total cardiac cases registered and treated at the Cardiac Centre of Ethiopia from February 2000 to April 2022, 30.8% (3257) were diagnosed with VHD. The most typical diagnosis for VHD was multi-valvular involvement, which accounted for 49.5% of cases (1612), followed by pulmonary stenosis (15%) and mitral regurgitation (14.3%). Females were more likely to develop valve diseases than males, being at the highest risk for each identified etiology of valve disease 1928 (59.2%). The majority percentages of the population affected by VHD were between 18 and 44 age category 1473 (45.2%). The most common etiology of VHD was rheumatic 2015 (61.87%), followed by congenital origin 828 (25.42%). Conclusion: VHD affects nearly one-third of all cardiac cases admitted to the hospital. Multi-valvular involvement is the most commonly diagnosed form of VHD. Rheumatic causes were more prevalent in this study. As found in this study, VHD affects a significant percentage of the population, which in turn could have an impact on the country's economy and deserve attention as a possible means of intervention.
ABSTRACT
OBJECTIVES: Rheumatic heart disease is endemic in sub-Saharan Africa. There is a paucity of data on the outcomes of valvular surgery for rheumatic heart disease in the developing world. The objective of this study was to evaluate the outcomes of aortic and mitral valve surgery for rheumatic heart disease in Ethiopia. METHODS: Between 2009 and 2017, 240 consecutive patients with rheumatic heart disease underwent aortic and/or mitral surgery at the Cardiac Center of Ethiopia in Addis Ababa. These surgeries were performed in the context of 22 international humanitarian missions. Median follow-up was 2.3 (interquartile range, 0.5-4.0) years and 96% complete. Outcomes were compared between patients who underwent mechanical valve implantation (n = 90, 38%), bioprosthetic valve implantation (n = 58, 24%), and valve repair (n = 92, 38%). RESULTS: Mean age of patients was 19 ± 8 years, and 136 patients (57%) were female. Operative mortality occurred in 5 patients (2.1%) and was not significantly different between the groups. Eleven additional patients (5%) died at follow-up, and 55 patients (23%) had at least 1 major adverse valve-related event. Propensity score-adjusted Cox regression analysis demonstrated higher rates of death in the bioprosthetic group compared with the mechanical group (hazard ratio, 8.82; 95% confidence interval, 1.64-47.39; P = .011). Survival was not significantly different between the repair and mechanical groups (hazard ratio, 1.09; 95% confidence interval, 0.17-7.16; P = .93). Likewise, rates of major adverse valve-related event were higher in the bioprosthetic group compared with the mechanical group (hazard ratio, 2.71; 995% confidence interval, 1.13-6.49; P = .025), but not significantly different between the repair and mechanical groups (hazard ratio, 1.98; 95% confidence interval, 0.89-4.39; P = .092). CONCLUSIONS: Left-sided valve surgery for rheumatic heart disease in sub-Saharan Africa is associated with acceptable perioperative outcomes, but a high incidence of major adverse valve-related event at follow-up. The use of bioprosthetic valves is associated with poor outcomes in this patient population.
