Abstract:
Purpose: Active heart surgery programs are few in sub Saharan Africa outside of South Africa, with
majority being low volume centers performing small numbers annually. We reviewed our long
term outcome to identify factors associated with increased morbidity and mortality, to guide future
choice of prosthetic valves in our mostly indigent patients afflicted with rheumatic valvular
disease. Methods: Retrospective analysis of patients who underwent heart valve replacement at
Lagos State University and Ahmadu Bello University Teaching Hospitals from November 2004 to
February 2009. Results: Twenty six patients, 19 (73.1%) females, age 12 - 47; mean 26.69 ± 9.87
years, underwent heart valve replacement. 19 (73.1%) patients had mitral and 7 (26.9%) aortic
valve replacement. Mechanical valve was implanted in all except in 2 (7.7%) patients. Left ventricular
ejection fraction was >50% in 14 (53.8%), 24 (92.3%) were in New York Heart Association
class III/IV, 10 (38.5%) had severe pulmonary hypertension and logistic euroscore was 5.84 ±
3.81. Operative mortality was 11.5% (3/26) and morbidity 7.7% (2/26). Follow-up for survivors
was 83.0 ± 27.9 months. 10-year freedom from bleeding and thromboembolism was 70.0% and
survival 86.0%. Linearized rate for bleeding was 4.58 and thromboembolism 1.52. Conclusion:
Late complications in survivors were primarily anticoagulant related occurring predominantly in
child bearing age females especially during pregnancy. Bleeding complications were often associated
with noncompliance due to poor socioeconomic status. With average life expectancy of 53
years for females, bioprosthetic valves despite higher structural failure rate, may be best suited
especially in child bearing age females still desirous of childbirth to decrease valve related complications.
Longer duration of follow-up and meta-analysis of future reported series from the subregion may help clarify the optimal prosthetic valve in sub Saharan Africa with its known poor
health infrastructures and delivery system.
