Figure 1
Number of patients who underwent surgery between 2006–2017: Inclusion and exclusion criteria.
Table 1
Demographics and surgical characteristics for patients in the Rwandan Rheumatic Heart Disease National Surgery Registry.
| Variable | Total | |
|---|---|---|
| n | % | |
| Province | ||
| Eastern | 56 | 29.3 |
| Kigali City | 36 | 18.8 |
| Northern | 41 | 21.5 |
| Southern | 34 | 17.8 |
| Western | 24 | 12.6 |
| Gender | ||
| Female | 107 | 56 |
| Male | 84 | 44 |
| Age category at surgery | ||
| Adult (>15 years) | 110 | 57.6 |
| Children (0–15years) | 81 | 42.4 |
| Ubudehe Category | ||
| Category 1 (poorest) | 27 | 14.1 |
| Category 2 | 73 | 38.2 |
| Category 3 | 88 | 46.1 |
| Category 4 (wealthiest) | 3 | 1.6 |
| Current Occupation | ||
| Employed | 57 | 29.8 |
| In school+ | 73 | 38.2 |
| Other | 11 | 5.8 |
| School age but not at school | 13 | 6.8 |
| Unemployed | 37 | 19.4 |
| Pre-operative NYHA | ||
| Class 1 | 0 | 0 |
| Class II | 72 | 37.7 |
| Class III | 89 | 46.6 |
| Class IV | 30 | 15.7 |
| Place of surgery* | ||
| Rwanda | 128 | 67.4 |
| India | 43 | 22.6 |
| Other | 19 | 10 |
| Type of surgery** | ||
| Bioprosthetic valve | 30 | 16.4 |
| Mechanical valve | 151 | 79.2 |
| Valve repair | 8 | 4.4 |
| Number of valves operated*** | ||
| One Valve | 127 | 68.3 |
| Two Valves | 53 | 28.5 |
| Three Valves | 6 | 3.2 |
[i] * 1 patient was missing data, ** 2 patients missing data, *** 5 patients missing data, + refers to patients who reported attending primary, secondary of tertiary level education on full time basis.
Table 2
Post surgery follow-up details for patients in the Rwandan Rheumatic Heart Disease National Surgery Registry.
| Variable | Total | |
|---|---|---|
| n | % | |
| Access to Anticoagulation (n = 163 restricted to those indicated for anticoagulation) | ||
| Yes | 161 | 98.8 |
| No | 2 | 1.2 |
| Most recent INR value* (Restricted to mechanical/valve repair n =157) | ||
| Abnormally low (0–1.4) | 24 | 15.29 |
| Mildly low (1.5–2.4) | 67 | 42.68 |
| Therapeutic (2.5–3.5) | 47 | 29.94 |
| Mildly high (3.6–4.5) | 11 | 7.01 |
| High (>4.5) | 8 | 5.10 |
| On penicillin oral and injection prophylaxis | ||
| Yes | 166 | 86.9 |
| No | 9 | 4.7 |
| Missing | 16 | 8.4 |
| Years of post-surgery follow-up | ||
| Less than 5 Years | 19 | 9.9 |
| 5–8 Years | 55 | 28.8 |
| 9–11 Years | 117 | 61.3 |
| Facility type for follow-up** | ||
| District Hospital | 86 | 45.5 |
| Referral Hospital | 100 | 52.9 |
| Provincial Hospital | 3 | 1.6 |
[i] * 2 patients with mechanical/valve repair missing data on most recent INR.
** 2 patients missing data on facility type.
Table 3
Most recent NYHA class by demographic, surgery and follow-up characteristics.
| Variable | Most recent NYHA | ||||
|---|---|---|---|---|---|
| Class I (n = 172) | Class II (n = 19) | P value | |||
| n | % | n | % | ||
| Gender | |||||
| Female | 93 | 86.9 | 14 | 13.1 | 0.08 |
| Male | 79 | 94.0 | 5 | 6 | |
| Age category at time of surgery | |||||
| Children (0–15 years) | 73 | 90.1 | 8 | 9.9 | 0.978 |
| Adult (>15 years) | 99 | 90 | 11 | 10 | |
| Ubudehe Category | |||||
| Category 1 (poorest) | 26 | 96.3 | 1 | 3.7 | 0.532 |
| Category 2 | 63 | 86.3 | 10 | 13.7 | |
| Category 3 | 80 | 90.9 | 8 | 9.1 | |
| Category 4 (wealthiest) | 3 | 100 | 0 | 0 | |
| Current Occupation | |||||
| Employed | 48 | 84.2 | 9 | 15.8 | 0.276 |
| In school+ | 69 | 94.5 | 4 | 5.5 | |
| Other | 10 | 90.9 | 1 | 9.1 | |
| School age but not at School | 11 | 84.6 | 2 | 15.4 | |
| Unemployed | 34 | 91.9 | 3 | 8.1 | |
| Preoperative NYHA | |||||
| Class I | 0 | 0.0 | 0 | 0.0 | 0.620 |
| Class II | 63 | 87.5 | 9 | 12.5 | |
| Class III | 82 | 92.1 | 7 | 7.9 | |
| Class IV | 27 | 90.0 | 3 | 10.0 | |
| Year of surgery | |||||
| 2006–2009 | 108 | 92.3 | 9 | 7.7 | 0.168 |
| 2010–2013 | 49 | 89.1 | 6 | 10.9 | |
| 2014–2017 | 15 | 78.9 | 4 | 21.1 | |
| Place of surgery* | |||||
| Rwanda | 117 | 91.4 | 11 | 8.6 | 0.306 |
| India | 36 | 83.7 | 7 | 16.3 | |
| Other | 18 | 94.9 | 1 | 5.1 | |
| Type of surgery** | |||||
| Bioprosthetic valve | 24 | 80 | 6 | 20 | 0.134 |
| Mechanical valve | 138 | 84.9 | 13 | 15.1 | |
| Valve repair | 8 | 100 | 0 | 0 | |
| Number of valves operated*** | |||||
| One valve | 117 | 92.1 | 10 | 7.9 | 0.255 |
| Two valves | 45 | 84.9 | 8 | 15.1 | |
| Three valves | 6 | 100 | 0 | 0 | |
| Province | |||||
| Eastern | 50 | 89.3 | 6 | 10.7 | 0.253 |
| Kigali City | 35 | 97.2 | 1 | 2.8 | |
| Northern | 34 | 82.9 | 7 | 17.1 | |
| Southern | 30 | 88.2 | 4 | 11.8 | |
| Western | 23 | 95.8 | 1 | 4.2 | |
[i] * 1 patient missing data, ** 2 patients missing data, *** 5 patients missing data, + refers to patients who reported attending primary, secondary of tertiary level education on full time basis.
Table 4
Follow up details by outcome (most recent NYHA).
| Variable | Most recent NYHA | ||||
|---|---|---|---|---|---|
| Class I | Class II | P value | |||
| Freq. | Perc. | Freq. | Perc. | ||
| Access to Anticoagulation (n = 163 restricted to those eligible for anticoagulation) | |||||
| No | 2 | 100.0 | 0 | 0.0 | 0.835 |
| Yes | 147 | 91.3 | 14 | 8.7 | |
| Most recent INR value (Restricted to mechanical/valve repair n = 157) | |||||
| Abnormally low | 24 | 100.0 | 0 | 0.0 | 0.469 |
| Mildly low | 61 | 91.0 | 6 | 9.0 | |
| Therapeutic | 42 | 89.4 | 5 | 10.6 | |
| Mild high | 10 | 90.9 | 1 | 9.1 | |
| High | 7 | 87.5 | 1 | 12.5 | |
| On penicillin oral and injection prophylaxis* | |||||
| No | 7 | 77.8 | 2 | 22.2 | 0.233 |
| Yes | 150 | 90.4 | 16 | 9.6 | |
| Years of post-surgery follow up | |||||
| Less than 5 Years | 108 | 92.3 | 9 | 7.7 | 0.168 |
| 5–8 Years | 49 | 89.1 | 6 | 10.9 | |
| 9–12 Years | 15 | 78.9 | 4 | 21.1 | |
| Facility† | |||||
| District Hospital | 79 | 91.9 | 7 | 8.1 | 0.615 |
| Referral Hospital | 88 | 88.0 | 12 | 12.0 | |
| Provincial Hospital | 3 | 100.0 | 0 | 0.0 | |
[i] * 16 patients missing data, † 2 patients missing data.