Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Open Heart. 2021 Aug;8(2). doi: 10.1136/openhrt-2021-001706.
Rheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment.
Clinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital's waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis.
Survival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working.
Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.
风湿性心脏病（Rheumatic Heart Disease，RHD）是中低收入国家（Low-income and Middle-income Countries，LMICs）的一个主要负担。心脏手术是唯一的根治性治疗方法。对于在 LMICs 中接受心脏手术的严重慢性 RHD 患者，我们知之甚少，术后随访的挑战是一个重要问题。在埃塞俄比亚亚的斯亚贝巴的提库安贝萨专科医院，我们旨在评估接受心脏直视手术的严重慢性 RHD 患者的病程和 12 个月结局，并与等待手术且仅接受药物治疗的对照组的自然病程进行比较。
在 2016 年 3 月至 2019 年 11 月的五次任务中，我们对 46 名接受手术的患者的临床数据和结局指标进行了登记，并与来自同一医院手术等待名单的 49 名对照组患者的第一年病程进行了比较。不良事件为死亡或并发症，如中风、其他血栓栓塞事件、出血、心力衰竭住院和感染性心内膜炎。
手术组的 12 个月生存率为 89%，无并发症生存率为 80%。尽管接受了心脏直视手术，存在固有风险，但手术组的结局指标在纳入手术等待名单后的第一年与对照组的自然病程相比不劣（p≥0.45）。除了 6 名手术患者外，所有患者在 12 个月后均达到纽约心脏协会（New York Heart Association，NYHA）I 级，84%的患者恢复了工作。
如果服务结构合理且规划得当，LMICs 可以开展严重慢性 RHD 的心脏手术。12 个月时的生存率和无并发症生存率与对照组相似。手术组的功能水平和恢复工作的比例较高。接受心脏手术的患者是否会有更好的长期预后，与高收入国家所知的情况一致，需要在未来的研究中进行评估。
