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ABSTRACT
Introduction. Although bioprostheses are recommended over mechanical valves in poorly compliant patients to limit the risks of valve related complications, their use in the young Africans is still limited due to early structural deterioration. We review the indications and early surgical outcomes following bioprosthetic replacement (BPR) in our institute over a 12-year period. Patients and methods. The clinical data of 29 patients who underwent BPR in our institute between August 2010 and September 2022 were retrospectively reviewed. Clinical profiles and early post-surgical outcomes were analyzed. Results. Females were predominant with a ratio of 0.70. The median age and the interquartile range (IQR) at surgery were 59.4 years (IQR 56-67). 65.5% of the patients were in New York Heart Association functional class > III. Twenty-five patients (86.2%) were in sinus rhythm. Degenerative and rheumatic etiologies were reported in 13 (44.8%) and 14 (48.3%) cases, respectively, followed by endocarditis in 2 (6.9%). Among the 29 patients, 14 (48.3%) had aortic replacement, 9 (31.1%) mitral replacement, 4 (13.8%) mitro-aortic replacement, 1 (3.4%) mitro-tricuspid replacement and 1 (3.4%) tricuspid replacement. The median cardiopulmonary bypass and cross-clamping times were 137 minutes (IQR 102.8-160.8) and 98 minutes (IQR 69.5-121.5) respectively. The operative mortality was 3.4% (1/29). Major postoperative complications were atrial fibrillation in 5 (17.2%) and reoperation for bleeding in 2 (6.9%). The intensive care unit length of stay was 2 days (IQR 2-3). Conclusion. Bioprosthetic valves were mainly implanted in older patients with similar rates of degenerative and rheumatic lesions. Early mortality is comparable to data from western series.
RÉSUMÉ
Introduction. L’utilisation des bioprothèses dans la population jeune africaine reste limitée malgré leur caractère peu thrombogène. Nous revisitons les indications et résultats précoces de remplacement valvulaire (RV) par bioprothèse dans notre institut. Patients et méthodes. Une analyse rétrospective des données cliniques, opératoires et postopératoires a été réalisée entre Août 2010 et Septembre 2022 su 29 patients opérés de RV par bioprothèse au Centre Cardiaque de Shisong-Cameroun. Résultats. L'âge médian et l'intervalle interquartile (IIQ) étaient de 59,4 ans (IIQ 56-67), un sex-ratio de 0,70. Dix-neuf (65,5 %) de patients avaient une dyspnée en classe NYHA > III. Vingt-cinq patients (86,2 %) étaient en rythme sinusal. Les étiologies dégénératives et rhumatismales représentaient 13 (44,8 %) et 14 (48,3 %) des cas respectivement, l’endocardite 2 (6,9 %) cas. Quatorze (48,3 %) avaient subi un remplacement aortique, 9 (31,1 %) un mitral, 4 (13,8 %) un mitro-aortique, 1 (3,4 %) un mitro-tricuspide et 1 (3,4 %) un tricuspide. La durée médiane de la circulation extracorporelle et du clampage aortique était respectivement 137 min (IIQ 102,8-160,8) et 98 min (IIQ 69,5-121,5). La mortalité opératoire de 3,4 %. Les complications postopératoires étaient la fibrillation auriculaire dans 5 cas (17,2 %) et la réintervention pour hémorragie dans 2 cas (6,9 %). La durée de séjour en soins intensifs était de 2 jours (IIQ 2-3). Conclusion. Les bioprothèses sont implantées chez les patients âgés comparé à ceux recevant les prothèses mécaniques dans notre institution. Le résultat chirurgical, mortalité précoce y compris, sont comparables à ceux des pays occidentaux.

Keywords

Bioprosthetic valve; sub-Saharan Africa; heart surgery. Bioprothèses valvulaires; chirurgie cardiaque; Afrique sub-saharienne.

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Mve Mvondo, C., Ngo Yon, L. C., Tsague Kengni, H. N., Ngatchou Djomo, W., & Ngowe Ngowe, M. (2023). Indications and Early Surgical Outcomes of Bioprosthetic Heart Valve Replacement in an African population. HEALTH SCIENCES AND DISEASE, 24(2). https://doi.org/10.5281/hsd.v24i2.4178
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