Short-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country, with comparison with an historical control group: an observational study
Mette E Estensen,
Rune Haaverstad,
Håvard Dalen,
Sintayehu Abebe,
Desalew Mekonnen,
Torbjørn Graven,
Nigussie Bogale,
Ståle Wågen Hauge,
Robert Matongo Persson,
Berhanu Nega,
Atle Solholm,
Marit Farstad,
Niels-Erik Nielssen,
Hege Kristin Brekke,
Kjell Vikenes
Affiliations
Mette E Estensen
Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Rune Haaverstad
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Håvard Dalen
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Sintayehu Abebe
Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
Desalew Mekonnen
Department of Cardiology, School of Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
Torbjørn Graven
Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
Nigussie Bogale
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Ståle Wågen Hauge
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Robert Matongo Persson
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Berhanu Nega
Department of Surgery, School of Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
Atle Solholm
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Marit Farstad
Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
Niels-Erik Nielssen
Clinic of Cardiology, Linköping University Hospital, Linköping, Sweden
Hege Kristin Brekke
Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
Kjell Vikenes
1 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Objectives Rheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment.Methods Clinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital’s waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis.Results Survival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working.Conclusions Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.
