Abstract:
Background: Rheumatic heart disease (RHD) is endemic in Tanzania. It is ranked third among the most common
causes of heart failure after hypertensive heart diseases and cardiomyopathies. This study aimed to determine the
predictors of early operative mortality for RHD at Muhimbili National Hospital, Tanzania.
Methods: This retrospective cross-sectional study of 212 patients operated due to RHD from May 2008 to
December 2012. Patients’ demographic and clinical data at admission and within 30 days of the index elective
cardiac surgery were recorded in a predefined clinical record form. Data were entered and analysed using
Statistical Package for Social Sciences version 24 and STATA version 13. The Chi-square and Fisher’s exact tests
were utilized to compare categorical variables. Variables with a p-value <0.2 at bivariable analysis were included
in a multivariable modified Poisson regression model.
Results: Out of 212 patients, 140 (66%) were females. The median age was 21 years (interquartile range 15 – 32
years). One hundred and forty-five (68.4%) patients underwent valve replacement, out of which 113 (77.9%) were
single (mitral), 17 (11.7%) aortic, and 15 (10.4%) double (aortic and mitral) valve replacement. Valve repair was
done in 42 (19.8%) patients, of which 41 were mitral and one aortic. Surgical mitral commissurotomy was
performed in 25 (11.8%) patients. Thirty (14.1%) patients died in-hospital. In multivariable analysis, mortality
was more than five times higher among patients who underwent double than single valve replacement {adjusted
prevalence ratio (95% CI) = 5.65 (2.46-12.99), p < 0.001}. The patient’s age, disease duration, ejection fraction,
surgical modality, pulmonary hypertension, intensive care unit stay were not predictors of mortality.
Conclusion: The in-hospital mortality observed in this study was higher than those reported in previous studies.
In patients with RHD, double valve replacement is associated with increased early mortality, which may require
greater technical expertise and careful postoperative management. Our findings need to be confirmed in
prospective studie
