Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option

Charles Mve Mvondo,Alessandro Giamberti,Marta Pugliese,Jerome Boombhi,Ellen Marie Dailor,Liliane Mfeukeu Kuate,David Chelo

doi:10.11604/pamj.2016.24.307.7504

Abstract

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.

Highlights

Mitral valve repair (MVR) has become the treatment of choice in degenerative etiology, the fundamentals of this surgery promoted by Carpentier [1] were developed in the rheumatic heart disease (RHD) era
"The French Correction" paper reported rheumatic mitral pathology in about sixty percent of the patients, and nearly ninety percent of children with rheumatic mitral lesions were eligible for valve repair
Thirty years after Carpentier's paper, RHD is still endemic in many poor regions such as sub-Saharan Africa; prosthetic mitral replacement (PVR) especially with mechanical devices has become the preferred option because repair of rheumatic valves is often associated with a high rate of failure and reoperation [2,3,4]

Summary

Introduction

Mitral valve repair (MVR) has become the treatment of choice in degenerative etiology, the fundamentals of this surgery promoted by Carpentier [1] were developed in the rheumatic heart disease (RHD) era. "The French Correction" paper reported rheumatic mitral pathology in about sixty percent of the patients, and nearly ninety percent of children with rheumatic mitral lesions were eligible for valve repair. These reconstructive techniques were desirable in patients coming from low-income regions, where postsurgical management of prosthetic valves could have been suboptimal. Given the known advantages of MVR over PVR [68], and the evolving techniques of mitral valve repair which have recently reported encouraging results in rheumatic lesions [9,10,11], the widespread use of prosthetic valves in the complex sociocultural scenario of sub-Saharan regions is becoming more questionable. It is appropriate to revisit the recommended surgical treatment, according to the patients' characteristics and the effectiveness of the current repair techniques as compared to PVR in these developing countries

Methods

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Conclusion