Long-term Outcome of Rheumatic Mitral Valve Surgery in Children From Low- and Middle-Income African Nations

Abstract

Background

There is limited information on rheumatic mitral valve surgery for children living in low- and middle-income African countries.

Patients and methods

From 1/1/1998 to 1/1/2024, a total of 276 children <18 years of age, coming from Africa, underwent mitral valve (MV) surgery in France. The majority of the patients were in New York Heart Association (NYHA) class III. Mécénat Chirurgie Cardiaque operates in France on children with pediatric cardiac diseases. There were 28 patients who had insertion of a bioprosthetic MV (BioV), 91 patients had placement of a mechanical mitral valve (MechV), and 157 patients had MV repair (MV repair).

Results

The in hospital mortality was 1.1% (3/276). There were 37 patients lost to follow-up. The overall mortality on patients with follow up was to 33% (78/239) : 71% (20/28) for BioV (P < .0001), 30% (24/81) for MechV and 26% (34/130) for MV repair. The actuarial survival at 20 years was similar for MechV and MV repair, 70% and 68%, respectively (P=ns). Follow-up was available for 83.7% of the patients and extended over 20 years; follow up was 95% in the last 13 years. MV repair demonstrated superior outcome during the first 15 years (P= .031). MechV had a higher mortality during the first 15 years due to complications of anticoagulation, but did not require reoperation and had a flat survival curve after 15 years.

Conclusion

Rheumatic MV surgery has a high mortality in the least developed African countries. Bioprosthetic mitral valve replacement was demonstrated to be a very high risk strategy. Patients undergoing mechanical valve operation had poor results due to anticoagulation. MV repair was the best surgical strategy when feasible, particularly in young children who can enjoy a better quality of life until adulthood,despite the risk of reoperation and the need for antibiotics.