Comparative study of short and middle terms morbidity between mechanical and bioprosthetic heart valve replacement in Burkina Faso.

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Résumé

Introduction : Establishing an independent cardiac surgical centre in Sub Saharan Africa is long and difficult. In this region, rheumatic valve disease is endemic and require mostly surgical therapy. Recently, open heart surgery has started in 2021 in Burkina Faso and since then, both procedures for congenital and acquired heart diseases have being performed. The authors report a comparative analysis of postoperative morbidity of mechanical heart valves (MHV) replacement versus bioprosthetic heart valves (BHV) performed at the unique cardiac surgery center of the country
Methods : comparative and analytical study with a retrospective data collection was conducted in the department of thoracic and cardiovascular surgery at the university hospital of Tengandogo over a period of four years from january 2021 to december 2024. Morbidity was compared in the two groups.
Results : 73 patients were inclued and the femal sex represented 53.5%. Mean age was 28.2 years old with extrems of 8 and 70 years old. Pathologies included mitral regurgitation (37%), mitral stenosis (27%), aortic regurgitation (24%), aortic stenosis (7.9%) and organic tricuspid regurgitation (4.1%). There was associated moderate to severe functional tricuspid regurgitation in 24.6% of the patients. MHV replacement repsented 80.2% vers 19.2% for BHV. Mechanical mitral valve replacement was the most frequent procedure (56.2%). Five etiologies were found ; they consisted of rheumatic disease (81%), degenative (7%), aneurysm (6%), infective endocarditis (5%) and congenital (1%). The mean cross clamping time during was 93.9 min for BHV and 92.4 min for MHV (p-value >0.9). Complications occured more in MHV than in BHV (p-value >0.9). Analysis of the duration of postoperative hospital stay showed that MHV patients had a longer stay than BHV patients. It was statistically significant with a p value of 0.008. Lastly, gross analysis of postoperative outcomes correlated with age showed a Fisher exact test with a p value of 0.001. Young adults tend to have uneventful postoperative outcomes compared to older patients.
Conclusion : Valve surgery is been performed in Burkina Faso for four years. MHV replacement is the most perfomed procedure for acquired diseases. Morbidity is higer in older people with a statistically significance. There were more complications in the group of MHV patients compared to BHV but not statistically significant. Time has come to develop valve repair surgery for VHD.

Mots-clés

rheumatic valve disease ; mechanical valve replacement ; bioprosthetic heart replacement ; cardiac surgery ; Burkina Faso