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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Outcome of left heart mechanical valve replacement in West African children - A 15-year retrospective study
Journal of Cardiothoracic Surgery, Volume 6, No. 1, Article 57, Year 2011
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Description
Background: The West African sub-region has poor health infrastructure. Mechanical valve replacement in children from such regions raises important postoperative concerns; among these, valve-related morbidity and complications of lifelong anticoagulation are foremost. Little is known about the long-term outcome of mechanical valve replacement in West Africa. We sought to determine the outcome of mechanical valve replacement of the left heart in children from this sub-region.Method: We conducted a retrospective review of all consecutive left heart valve replacements in children (< 18 years old) from January 1993 - December 2008. The study end-points were mortality, valve-related morbidity, and reoperation.Results: One hundred and fourteen patients underwent mitral valve replacement (MVR), aortic valve replacement (AVR) or mitral and aortic valve replacements (MAVR). Their ages ranged from 6-18 years (13.3 ± 3.1 years). All patients were in NYHA class III or IV. Median follow up was 9.1 years. MVR was performed in 91 (79.8%) patients, AVR in 13 (11.4%) and MAVR in 10 (8.8%) patients. Tricuspid valve repair was performed concomitantly in 45 (39.5%) patients.There were 6 (5.3%) early deaths and 6 (5.3%) late deaths. Preoperative left ventricular dysfunction (ejection fraction < 45%) was the most important factor contributing to both early and late mortality. Actuarial survival at 1 and 15 years were 98.1% and 94.0% respectively. Prosthetic valve thrombosis occurred in 5 patients at 0.56% per patient-year. There was 1(0.9%) each of major bleeding event and prosthetic valve endocarditis. Two reoperations were performed at 0.22% per patient-year. Actuarial freedom from reoperation was 99.1% at 1 and 10 years, and 85.1% at 15 years.Conclusion: Mechanical valve replacement in West African children has excellent outcomes in terms of mortality, valve-related events, and reoperation rate. Preoperative left ventricular dysfunction is the primary determinant of mortality within the first 2 years of valve replacement. The risk of valve-related complications is acceptably low. Anticoagulation is well tolerated with a very low risk of bleeding even in this socioeconomic setting. © 2011 Edwin et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Edwin, Frank
Ghana, Accra
Korle bu Teaching Hospital
Aniteye, Ernest A.
Ghana, Accra
Korle bu Teaching Hospital
Tettey, Mark Mawutor
Ghana, Accra
Korle bu Teaching Hospital
Tamatey, Martin M.
Ghana, Accra
Korle bu Teaching Hospital
Frimpong-Boateng, Kwabena
Ghana, Accra
Korle bu Teaching Hospital
Statistics
Citations: 23
Authors: 5
Affiliations: 1
Identifiers
Doi:
10.1186/1749-8090-6-57
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Multi-countries