Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda.
Glob Heart
; 18(1): 62, 2023.
Article
em En
| MEDLINE
| ID: mdl-38028964
ABSTRACT
Background:
Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low- and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that access surgery have not been described in Uganda.Objectives:
To describe the volume and type of rheumatic heart disease (RHD) valvular interventions and the outcomes of operated patients in the Uganda RHD registry.Methods:
We performed a retrospective cohort study of all valve surgery procedures identified in the Uganda RHD registry through December 2021.Results:
Three hundred and sixty-seven surgical procedures were performed among 359 patients. More than half were among young (55.9% were ≤20 years of age), female (59.9%) patients. All patients were censored at 15 years. The median (IQR) follow up period was 43 (22,79) months. Nearly half of surgeries (46.9%) included interventions on multiple valves, and most valvular operations were replacements with mechanical prostheses (96.6%). Over 70% of the procedures were sponsored by charity organizations. The overall mortality of patients who underwent surgery was 13% (47/359), with over half of the mortalities occurring within the first year following surgery (27/47; 57.4%). Fifteen-year survival or freedom from re-operation was not significantly different between those receiving valve replacements and those receiving valve repair (log-rank p = 0.76).Conclusions:
There has been increasing access to valve surgery among Ugandan patients with RHD. Post-operative survival is similar to regionally reported rates. The growing cohort of patients living with prosthetic valves necessitates national expansion and decentralization of post-operative care services. Major reliance on charity funding of surgery is unsustainable, thus calling for locally generated and controlled support mechanisms such as a national health insurance scheme. The central illustration (Figure 1) provides a summary of our findings and recommendations.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Cardiopatia Reumática
/
Doenças das Valvas Cardíacas
Limite:
Female
/
Humans
País/Região como assunto:
Africa
Idioma:
En
Revista:
Glob Heart
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Uganda