Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda.

Autor:	Rwebembera J; Uganda Heart Institute, Kampala, Uganda., Chang AY; Department of Epidemiology and Population Health, Stanford University School of Medicine, USA.; Center for Innovation in Global Health, Stanford University, USA., Kitooleko SM; Uganda Heart Institute, Kampala, Uganda., Kaudha G; Uganda Heart Institute, Kampala, Uganda., de Loizaga S; Stanford Cardiovascular Institute, Stanford University, USA.; Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH 45229, USA., Nalule M; Uganda Heart Institute, Kampala, Uganda., Ahabwe K; Uganda Heart Institute, Kampala, Uganda., Zhang W; Uganda Heart Institute, Kampala, Uganda., Okello E; Uganda Heart Institute, Kampala, Uganda.; School of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA., Sinha P; Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Mwambu T; Uganda Heart Institute, Kampala, Uganda., Sable C; Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Beaton A; Stanford Cardiovascular Institute, Stanford University, USA.; Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Longenecker CT; Pediatric Cardiology, Children's National Hospital, Washington, District of Columbia, USA.
Jazyk:	angličtina
Zdroj:	Global heart [Glob Heart] 2023 Nov 14; Vol. 18 (1), pp. 62. Date of Electronic Publication: 2023 Nov 14 (Print Publication: 2023).
DOI:	10.5334/gh.1260
Abstrakt:	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. Competing Interests: The authors have no competing interests to declare. (Copyright: © 2023 The Author(s).)
Databáze:	MEDLINE
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