CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 AFRICA 43 The optimal management of patients with atrial fibrillation undergoing heart valve repair or replacement remains unresolved. There have, over the years, been strongly voiced opinions about left atrial appendage amputation and the various modifications of the Cox procedure. There is still no consensus on the optimal strategy. Nyamande and colleagues (page 60) report a retrospective analysis of their experience and point out that their results are similar to reports from other parts of the world. However, a significant number of their patients reverted to atrial fibrillation. Whatever strategy is adopted there can be no way to escape the need for meticulous attention to anticoagulation after valve repair or replacement in all patients and particularly in those who have been in atrial fibrillation. The endpoint the authors measured was cardiac rhythm. The most important and relevant endpoint is cardioembolic events, the most clinically important of which is stroke. Clinicians recognise that stroke after major cardiac surgery remains a significant problem, particularly in the elderly. It is encouraging that cardiac surgeons, Tekin and colleagues (page 44), have examined whether surgical technique contributes to the risk of stroke. Many surgical techniques have not been subjected to scientific scrutiny but remain entrenched by firmly held opinion. The analysis is neutral and does not answer the question, but the authors should be commended for attempting to answer an important question. The prevalence of risk factors for cardiac diseases remains incompletely explored in African populations. This is particularly important as Africa is currently faced with a double burden of communicable and non-communicable diseases (NCDs). The latter, which was less common in past decades, is predicted to take the lead in the next decade. Knowledge of the prevalence of risk factors is important if Africa is to prepare to reduce the predicted rise in NCDs. There is not a great deal of information on risk factors for cardiovascular disease in African populations. Odili and co-authors (page 52) and all those involved in the ambitious REMAH study are to be congratulated on concluding a landmark study to close some of the gaps in our knowledge. It is clear that cardiological expertise to diagnose and cardiac surgical facilities to treat the victims of rheumatic heart disease in Africa are sorely lacking. The report from Coulibaly and co-workers (page 79) regarding the effort in Mali is a wonderful example of the generous assistance of donors from abroad to alleviate the sad situation in Africa. It shows what can be done with goodwill and funding. I look forward to the follow-up report from this and other groups doing similar work in Africa, which will detail not just patients treated but numbers of local staff trained and able to carry on the important work in their home country. The report of the 15th PASCAR and Kenya Cardiac Society congress (page 88) is a remarkable document. The very existence of these organisations, the many national bodies, and their close collaboration would have been almost unthinkable in the 1970s and 80s. The fact that they do exist and collaborate collegially is a tribute to all who have worked so hard for many years to unite all African societies seeking to improve cardiovascular health for Africans. PJ Commerford Editor-in-Chief From the Editor’s Desk
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