Practice and clinical outcomes of valvular surgery for rheumatic heart disease in africa: a scoping review

Abstract

BACKGROUND: Rheumatic heart disease is prevalent in Africa, but advanced cardiac care for the condition, which includes valve surgery, is limited. This study examined rheumatic heart disease surgical management and clinical outcomes in Africa. METHODS: This study followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. We conducted a comprehensive search of PubMed, Embase, Scopus, and Web of Science for keywords related to “rheumatic heart disease,” “valve surgery,” and “Africa.” Clinical studies published in African countries on valve surgery for rheumatic heart disease were included. RESULTS: The review included 17 studies from 10 countries. The prevalence of rheumatic heart disease had a female predominance (n = 1313/2367, 55.5%). Mitral valve procedures were universally reported. 7 studies highlighted moderate to severe valve disease severity. Clinical improvement was noted in two studies, with patients in NYHA Class I or II. Reoperation rates varied from 1.45% to 17%, and mortality rates from 3.85% to 22.67%. Hospital stays ranged from 5 to 16 days, and ICU stays from 2 to 3 days. Post-operative complications included thromboembolic disease, hypertrophic scars, infective endocarditis, left ventricular dysfunction, bioprosthetic valve dysfunction, arrhythmias, and neurological events such as stroke. CONCLUSION: Valve surgery for rheumatic heart disease in Africa shows promising clinical outcomes but faces challenges like outcome variability, postoperative complications, and limited infrastructure. Addressing diagnostic issues, enhancing follow-up care, and building healthcare capacity are essential for expanding effective surgical interventions and improving patient outcomes.