Clinical and Evolutionary Profile of Patients with Rheumatic Valvulopathy Operated Versus Not Operated in Chad

Abstract

Introduction: The aim of this study was to describe the clinical and evolutionary profile of patients with rheumatic valvulopathy, operated versus non-operated in Chad. Patient and methods: This was a prospective, multicenter cohort study carried out in the cardiology departments of the National Reference University Hospital Centre, cardiology Department, Renaissance University Hospital Center, and Bon Samaritain University Hospital, of N’Djamena city. It was spread over a six-year period, from January 1, 2015, to December 31, 2020. Were included in the study, all patients who had been seen on an outpatient basis and/or hospitalized for rheumatic valvular disease in the aforementioned in the aforementioned during the study period. The clinical and evolutionary characteristics of operated patients were compared with those of non-operated patients using, as required, Pearson’s chi2 test, Fisher’s exact test or Student’s t-test. The threshold of statistical significance was p<0.05. Results: A total of 80 patients (22%) had undergone surgery out of the 364 included. Valve replacement by mechanical prosthesis accounted for 77% of procedures, and valve plasty for 45%. The mean age of operated patients was 33 vs. 31 for non-operated patients (p=not significant NS). Female gender was found in 57% of operated patients vs. 52% of non-operated patients (p=NS). Dyspnea on exertion was present on admission in 65% of operated patients vs. 82% of non-operated patients (p<0.001). LVEF in operated patients was 61% vs 59% in non-operated patients (p=NS), mean LV end-diastolic diameter was 53.2 mm vs. 54.7 mm (p=NS) and PAPs were 43 mmHg vs 54 mmHg (p=0.0001). During follow-up, 36% of operated patients vs. 47% of non-operated patients had a hemodynamic complication (p=0.07), 12% of operated patients had a thromboembolic complication vs. 5% of non-operated patients (p=0.01), 13% of operated patients had atrial fibrillation vs. 15% of non-operated patients (p=0.12). Ten (10) deaths (12%) were recorded among operated patient’s vs 28 deaths (10%) among non-operated patients (p=NS). Conclusion: Morbidity and mortality in patients with rheumatic valvular disease remain high, even in patients undergoing surgery. even in patients who have undergone surgery. While there is a need to make surgery accessible to as many patients as possible, good therapeutic education and improvement of the patient's care pathway are essential. Those are the keys to effective, safe care.