ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Valve Disease
Mid-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country: an observational study with historical controls
Stale Wagen Hauge 1,2,3
Mette E. Estensen 4
Robert Matongo Persson 5,6
Dejuma Yadeta 7
Chala Fekadu 8
Abebe Tessema 9
Vegard Ellensen 5
Atle Solholm 5
Thomas Dolven 10
Nigussie Bogale 2
Hans Martin Flade 11
Kjell Vikenes 2,6
Havard Dalen 12,13,11
Rune Haaverstad 2,6
1. Hjerteavdelingen, St Olav's Hospital HF, Trondheim, Norway
2. Hjarteavdelinga, Haukeland Universitetssjukehus, Bergen, Norway
3. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
4. Oslo universitetssykehus, Oslo, Norway
5. Hjarteavdelinga, Haukeland Universitetssjukehus Avdeling for thoraxmedisin, Bergen, Norway
6. Universitetet i Bergen Det medisinske fakultet, Bergen, Norway
7. Department of Cardiology,, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
8. Department of Cardiology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
9. Department of surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
10. Haukeland Universitetssykehus, kirurgisk service klinikk, Bergen, Norway
11. Norges teknisk-naturvitenskapelige universitet Institutt for sirkulasjon og bildediagnostikk, Trondheim, Norway
12. Sykehuset Levanger, Levanger, Norway
13. Hjerteavdelinga, St Olav's Hospital HF, Trondheim, Norway
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Abstract
ABSTRACT Objectives The literature is sparse regarding the outcome after valvular surgery in patients with severe chronic rheumatic heart disease (RHD) in low-and middle-income countries (LMICs). We aimed to evaluate the mid-term outcome in patients with severe chronic RHD undergoing open-heart surgery in Ethiopia, and evaluate the durability of the operated valves during follow-up. Methods Observational design where 104 patients were screened for cardiac surgery whereof 52 were excluded. Outcome measures, clinical and echocardiographic data after cardiac surgery were available in 52 patients. Survival was compared to a cohort of 157 control patients recruited from the waiting list based on similar characteristics. 108 were lost to follow-up or underwent surgery or interventions by others, leaving 49 for comparison. The function of the repaired valves or valvular prosthesis were examined by echocardiography. Results Mean follow-up time of the 52 (65% women) surgical patients and 49 (76% women) controls was 4.1 years and 3.6 years, respectively. Of the surgical group, 46 (88%) 25 (48%) and 18 (35%) patients underwent operations of mitral valve, tricuspid valve and aortic valve, respectively. Survival rate at last follow-up was 83% in the surgical group and 57% in the control group, (P=0.004). At last follow-up four patients had moderate valvular obstruction and none had severe valvular dysfunction. Conclusions Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is well-structured and can improve survival at mid-term follow-up. The durability of both repaired and replaced valves were good.
Summary
Keywords
Echocardiography, Heart Valve Prosthesis, heart valve surgery, Mitral regurgitation, Mitral stenosis, Rheumatic Heart Disease, sub-Saharan Africa
Received
09 December 2025
Accepted
12 February 2026
Copyright
© 2026 Hauge, Estensen, Persson, Yadeta, Fekadu, Tessema, Ellensen, Solholm, Dolven, Bogale, Flade, Vikenes, Dalen and Haaverstad. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Stale Wagen Hauge
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