Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option.
Rheumatic valve disease, a consequence of acute rheumatic fever, remains endemic in developing countries in the sub-Saharan region where it is the leading cause of heart failure and cardiovascular death, involving predominantly a young population. The involvement of the mitral valve is pathognomonic and mitral surgery has become the lone therapeutic option for the majority of these patients. However, controversies exist on the choice between valve repair or prosthetic valve replacement. Although the advantages of mitral valve repair over prosthetic valve replacement in degenerative mitral disease are well established, this has not been the case for rheumatic lesions, where the use of prosthetic valves, specifically mechanical devices, even in poorly compliant populations remains very common. These patients deserve more accurate evaluation in the choice of the surgical strategy which strongly impacts the post-operative outcomes. This report discusses the factors supporting mitral repair surgery in rheumatic disease, according to the patients' characteristics and the effectiveness of the current repair techniques compared to prosthetic valve replacement in developing countries.
Division of Cardiac surgery, Cardiac Centre of Shisong, Kumbo, Cameroon.
Charles Mve
CM
Mvondo
Divison of Cardiac Surgery, University of Rome Tor Vergata, Rome, Italy.
Marta
M
Pugliese
Division of Cardiac surgery, Cardiac Centre of Shisong, Kumbo, Cameroon.
Alessandro
A
Giamberti
Department of Pediatrics, Chantal Biya Foundation, Yaoundé, Cameroon.
David
D
Chelo
Department of Internal Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon.
Liliane Mfeukeu
LM
Kuate
Department of Cardiology, Yaoundé General Hospital, Yaoundé Cameroon.
Jerome
J
Boombhi
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Ellen Marie
EM
Dailor
D017954:Africa South of the Sahara; D006349:Heart Valve Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D012214:Rheumatic Heart Disease / Q000473:pathology / Q000601:surgery*
Rheumatic heart disease; mitral valve repair; valve replacement