Objectives Rheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment. Methods Clinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital’s waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis. Results Survival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working. Conclusions Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies. Data are available on reasonable request to the authors.

中文翻译：

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低收入国家严重慢性风湿性心脏病心脏直视手术后短期结果与历史对照组的比较：一项观察性研究

目的 风湿性心脏病 (RHD) 是低收入和中等收入国家 (LMIC) 的主要负担。心脏手术是唯一的治疗方法。对在 LMIC 进行手术的严重慢性 RHD 患者知之甚少，术后随访的挑战是一个重要问题。在埃塞俄比亚亚的斯亚贝巴的 Tikur Anbessa 专科医院，我们旨在评估接受心脏直视手术的严重慢性 RHD 患者的病程和 12 个月的结果，与等待手术和仅接受内科手术的对照组的自然病程进行比较。治疗。方法 对 2016 年 3 月至 2019 年 11 月在 5 次出院期间手术的 46 名患者进行临床数据和结果测量，并与来自同一医院等待手术的 49 名对照队列的第一年过程进行比较。不良事件是死亡或并发症，如中风、其他血栓栓塞事件、出血、心力衰竭住院和感染性心内膜炎。结果手术组12个月生存率为89%，无并发症生存率为80%。尽管接受了心脏直视手术，但由于其固有的风险，手术组在列入等候名单后的第一年的结果指标不劣于对照组的自然病程（p≥0.45）。12 个月后，除 6 名外科手术患者外，所有患者均属于纽约心脏协会 I 级，84% 的患者已恢复工作。结论 如果服务结构化和有计划，重度慢性 RHD 的心脏手术在中低收入国家是可行的。存活率和无并发症存活率在 12 个月时与对照组相似。手术组功能水平和复工率高。接受心脏手术的患者是否会有更好的长期预后，与高收入国家已知的一致，需要在未来的研究中进行评估。数据可应作者的合理要求提供。