Morbi Mortality after Cardiac Surgery for Rheumatic Valvulopathy in Mali: Correlation with AMBLER Prognostic Score

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Introduction: Rheumatic heart disease remains a major public health problem worldwide. African populations pay a heavy price for this condition because of socio-economic and health conditions responsible for delayed diagnosis, and limited access to cardiac surgery. Objective: To report the morbidity and mortality of a series of patients operated on for rheumatic valvular disease and to compare its correlation with Ambler’s prognostic score. Patients and Methods: Descriptive and analytical study of all patients operated on for rheumatic valvulopathy from 01/01/2019 to 31/12/2021. Results: 160 patients were included. The mean age of patients was 23.93. Females predominated at 56.3%. Delay in treatment was between 1 and 3 years in 49.4% of patients. At preoperative assessment, Systolic Pulmonary Arterial Pressure was >60 mmHg in 43.1% of our patients. The mean Ambler score was 6.68, equivalent to a mean risk of peri-operative mortality of 4.1%. Mitral valve replacement was performed in 81.9%; aortic valve replacement in 18.8%. The average extubation time was between 3 and 5 hours in 43.1% of patients. We recorded a peri-operative mortality of 6.9% and a late mortality of 8.1% (36 months). Post-operative hemodynamic complications were correlated with the time to management of valve disease: p = 0.036; the presence of preoperative PAH was correlated with the post-operative occurrence of respiratory complications: p = 0.029; the presence of preoperative complete arrhythmia due to atrial fibrillation (CAF) was correlated with the post-operative occurrence of renal failure p = 0.017. There was no correlation between Ambler score and peri-operative mortality in our series. Conclusion: Cardiac surgery faces many difficulties in sub-Saharan Africa. Risk stratification scores in cardiac surgery are not adapted. The establishment of a pan-African exchange network would be a way of improving this surgical practice in our countries.

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