Asra Wahid1, Asna Sulaiman1, Osman Faheem1, Hasanat Sharif1

1Aga Khan University Hospital, Karachi, Pakistan

A great burden of aortic valve disease falls on rheumatic heart disease (RHD) in low- and middle-income countries compared to the degenerative pathologies of the West. Surgical aortic valve replacement (AVR) has been the standard of care for past five decades and transition to interventional procedures is gradual in under-resourced settings. Exact etiology and surgical outcomes are poorly understood and under reported. This study was conducted to determine the prevalence and surgical outcomes of aortic disease at our center.

A retrospective review was performed on 149 patients who underwent surgical AVR – isolated and dual – from 2002 – 2007 at our institute. Demographics, etiology of valve disease, echocardiographic, and five-year follow up findings were collected.

Baseline characteristics and operative variables are shown in Table 1. Pre-operatively, severe aortic stenosis, 43.2% was more prevalent in older patients; while severe aortic regurgitation, 32.6% was mostly in younger patients.

Length of ICU stay was of 4(3 – 5) days. Postoperative complications included; in-hospital mortality, 0.7%; ventricular arrhythmia, 3.4%; heart block, 5.4%; prolonged intubation, 18.2%; renal failure, 6.1%. Mean follow-up time was (53 ± 3.9) months.  A high number of patients were lost to follow up, n=33(22.1%). One-year and five-year survival were 97.4% and 95.7%. Long term complications were redo valve replacement, 0.9%; endocarditis, 2.6%; atrial fibrillation, 3.5%; aortic regurgitation, 7.8%.

We concluded that a significantly younger but diseased population had aortic valve disease compared to the West with the most predominant etiology being RHD and a high prevalence of BAV. Loss to follow up remains a problem in our under-resourced population. In LMICs like Pakistan, surgical AVR can be relied upon to produce substantial outcomes for aortic disease in low to moderate risk patients.