Experience with Prosthetic Valve Replacement in Indigents with Rheumatic Heart Disease in Nigeria: 10-Year Follow-Up


Purpose: Active heart surgery programs are few in sub Saharan Africa outside of South Africa, with majority being low volume centers performing small numbers annually. We reviewed our long term outcome to identify factors associated with increased morbidity and mortality, to guide future choice of prosthetic valves in our mostly indigent patients afflicted with rheumatic valvular disease. Methods: Retrospective analysis of patients who underwent heart valve replacement at Lagos State University and Ahmadu Bello University Teaching Hospitals from November 2004 to February 2009. Results: Twenty six patients, 19 (73.1%) females, age 12 - 47; mean 26.69 ± 9.87 years, underwent heart valve replacement. 19 (73.1%) patients had mitral and 7 (26.9%) aortic valve replacement. Mechanical valve was implanted in all except in 2 (7.7%) patients. Left ventricular ejection fraction was >50% in 14 (53.8%), 24 (92.3%) were in New York Heart Association class III/IV, 10 (38.5%) had severe pulmonary hypertension and logistic euroscore was 5.84 ± 3.81. Operative mortality was 11.5% (3/26) and morbidity 7.7% (2/26). Follow-up for survivors was 83.0 ± 27.9 months. 10-year freedom from bleeding and thromboembolism was 70.0% and survival 86.0%. Linearized rate for bleeding was 4.58 and thromboembolism 1.52. Conclusion: Late complications in survivors were primarily anticoagulant related occurring predominantly in child bearing age females especially during pregnancy. Bleeding complications were often associated with noncompliance due to poor socioeconomic status. With average life expectancy of 53 years for females, bioprosthetic valves despite higher structural failure rate, may be best suited especially in child bearing age females still desirous of childbirth to decrease valve related complications. Longer duration of follow-up and meta-analysis of future reported series from the sub region may help clarify the optimal prosthetic valve in sub Saharan Africa with its known poor health infrastructures and delivery system.

Share and Cite:

Nwiloh, J. , Oludara, M. , Adebola, P. , Edaigbini, S. , Danbauchi, S. and Sowunmi, A. (2015) Experience with Prosthetic Valve Replacement in Indigents with Rheumatic Heart Disease in Nigeria: 10-Year Follow-Up. World Journal of Cardiovascular Surgery, 5, 75-81. doi: 10.4236/wjcs.2015.58013.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Anyanwu, C., Ihenacho, H., Okoroma, E., Nwafo, D. and Umeh, B. (1982) Initial Experience with Open Heart Surgery in Nigeria. Tropical Cardiology, 8, 123-127.
[2] Eze, J. and Ezemba, N. (2007) Open Heart Surgery in Nigeria: Indication and Challenges. Texas Heart Journal, 34, 8- 10.
[3] Kimmel, S., Chen, Z. and Price, M. (2007) The Influence of Patient Adherence on Anticoagulation Control with Warfarin. Archives of Internal Medicine, 167, 229-235.
[4] McCarthy, P. and Malaisrie, S. (2009) Mitral Valve Repair and Replacement, Including Associated Atrial Fibrillation and Tricuspid Regurgitation. In: Otto, C.M. and Bonow, R.O., Eds., Valvular Heart Disease: A Companion to Braunwald’s Heart Disease, 3rd Edition, Saunders/Elsevier, Philadelphia, 291-306.
[5] Isaacs, A., Shuhaiber, J., Salemi, A., Isom, W. and Sedrakyan, A. (2015) National Trends in Utilization and In-Hospital Outcomes of Mechanical versus Bioprosthetic Aortic Valve Replacements. The Journal of Thoracic and Cardiovascular Surgery, 149, 1262-1269.
[6] Edwin, F., Aniteye, E., Tettey, M., Tamatey, M. and Frimpong-Boateng, K. (2011) Outcome of Left Heart Mechanical Valve Replacement in West African Children—A 15-Year Retrospective Study. Journal of Cardiothoracic Surgery, 6, 57.
[7] Williams, A. and Van Riet, S. (2006) The On-X Heart Valve: Midterm Results in a Poorly Anticoagulated Population. The Journal of Heart Valve Disease, 15, 80-86.
[8] Danbauchi, S., Alhassan, A. and David, S. (2004) Spectrum of Rheumatic Heart Disease in Zaria, Northern Nigeria. Annals of African Medicine, 3, 17-21.
[9] Al-Lawati, A., Venkitraman, M., Al-Delaime, T. and Valliathu, J. (2002) Pregnancy and Mechanical Heart Valves Replacement; Dilemma of Anticoagulation. European Journal Cardio-Thoracic Surgery, 22, 223-227.
[10] Geelani, M., Singh, S., Verma, A., Nagesh, A. and Betigeri, V. (2005) Anticoagulation in Patients with Mechanical Valves during Pregnancy. Asian Cardiovascular and Thoracic Annals, 13, 30-33.
[11] Legg, M., Mathews, E. and Pelzer, R. (2012) The Design and Development of a Stented Tissue Mitral and Aortic Heart Valve Replacement for Human Implantation. Cardiovascular Journal of Africa, 23, 126-130.
[12] Rahimtoola, S.H. (2010) Choice of Prosthetic Heart Valve in Adults. Journal of the American College of Cardiology, 55, 2413-2426.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.