AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 18 Results From October 2021 through May 2023, 30 patients (24 female and 6 male patients; mean age, 40 ± 14 years) underwent the CM-IV procedure. Ninety percent of patients were in longstanding persistent AF, 7% were in paroxysmal AF, and 3% were in persistent AF. The mean size of the left atrium on pre-operative echocardiography was 6.7±1 (range, 4.7–13.5 cm). All the patients had an underlying RHD and underwent cardiac operations. The majority (56%) had isolated mitral valve replacement, 40% had mitral and aortic valve replacement, and 1 patient had isolated mitral valve repair. There were 7 peri-operative deaths; subsequently, 23 patients made it to the minimum follow-up period of 3 months. NSR was restored in 78% (18/23) of the patients. Freedom from AF recurrence was 70% (16/23) at 6 months. Conversion rate to NSR was not found to have a statistically significant association with the type and duration of AF or the pre-operative size of the left atrium. Conclusion The CM-IV has satisfactory long-term efficacy even in the presence of dilated atrial chambers in patients with RHD. Early surgical therapy, aggressive left atrial reduction, and correction of tricuspid regurgitation at the time of surgery may increase the longterm success rate. Long-term follow-up of the patients will help accurately measure the overall outcome and identify contributing factors. Submission ID: 25 PRE-OPERATIVE MELD-NA SCORE AS AN INDEPENDENT PREDICTOR OF PERI-OPERATIVE MORTALITY AFTER VALVE SURGERY IN RHEUMATIC HEART DISEASE PATIENTS: EXPERIENCE FROM TENWEK HOSPITAL AREGA F. LETA (MD), YONAS A. TEFERI (MD), LIDETU KAYAMO (MD), EVALINE CHEMUTAI Background Most pre-operative risk scores for valve replacement in cardiac surgery have been implemented using non-RHD cases. These were difficult to translate to RHD patients as the pathophysiology is considered different from other cardiac surgical pathologies. This study aims to assess the use of the Model for End-stage Liver Disease score, including sodium (MELD-Na), as a pre-operative predictor of mortality after cardiac surgery in RHD patients. Methods This retrospective cohort study was conducted at Tenwek Hospital, Kenya. Our study comprised 94 patients who underwent open heart valve replacement surgery from March 2022 to March 2023. The time zero for follow-up in this study was the date of surgery. Those patients who underwent mitral valve replacement (MVR), aortic valve replacement (AVR), and tricuspid valve repair (TVr) surgery were included in the study. Tenwek Hospital’s electronic medical record system was used to collect patients’ clinical data. IBM SPSS Statistics 27.0 was used to run the analysis of data using the Chisquare and binary logistic regression. Results The study included 94 patients (61.7% female, 38.3% male; median age 23). Most (68.1%) of the study subjects had mitral valve disease (35.1% had mitral regurgitation and 33% had mitral stenosis). Seven percent of the patients had aortic insufficiency (AI). In addition, 43.6% had severe tricuspid regurgitation (TR) and 29.8% had moderate TR. MVR was done for 67% of patients, AVR for 5.3%, and MVR plus AVR for 26.6%. The percentage of patients who underwent TVr together with MVR, AVR, or both was 45.7%. The overall mortality rate of this study was 10.6%. In binary logistic regression analysis, a higher MELD-Na score was significantly associated with perioperative mortality (a P-value of <0.001). Conclusion The study showed that increasing in MELD-Na score increases the risk of operative mortality after RHD valve surgery. Preoperative MELD-Na score can be used as risk stratification in RHD patients undergoing cardiac surgery. However, further prospective multicenter studies with larger sample sizes and longer study duration may be needed to support this conclusion. Fig. 1: Mortality based on MELD-Na score category Submission ID: 26 PRIMARY CAUSES OF HEART FAILURE AND DIRECT MEDICAL COST OF HOSPITALIZATION AT MOI TEACHING AND REFERRAL HOSPITAL, KENYA WAUYE VM1, ODUOR CO1, BARASA FA2 1 DEPARTMENT OF INTERNAL MEDICINE, MOI UNIVERSITY 2 DEPARTMENT OF CARDIOLOGY, MOI TEACHING AND REFERRAL HOSPITAL, KENYA Background Heart failure (HF) is an emerging global contributor to cardiovascular morbidity and mortality, but data on its primary causes in view of the ongoing epidemiologic transition and direct medical cost of HF hospitalization is limited in Kenya, whose gross monthly household income is Kshs. 20,122.23. Methods This was a prospective study conducted at Moi Teaching and Referral Hospital. Primary causes were extracted from the echocardiogram reports and adjudicated by the study cardiologist. Direct medical cost of hospitalization was derived using microcosting and healthcare system perspective, and reported as per patient per day. Drivers of overall cost were explored using linear regression model with standardized β-coefficients. Primary Cause n (%) 95% CI Cost/pt/dy in Kshs (SD) LOS (SD) of Heart Failure Cor Pulmonale 41 (28.9) 21.1 – 37.9 9,696.38 (5,646.20) 10.5 (6.9) Cardiomyopathy 37 (26.1) 18.3 – 35.0 12,268.08 (7,816.12) 11.3 (8.4) Rheumatic Heart 28 (19.7) 12.0 – 28.7 15,299.08 (13,196.89) 8.8 (7.1) Disease Hypertensive Heart 24 (16.9) 9.2 – 25.9 8,934.33 (3,757.89) 10.6 (7.0) Disease Ischaemic Heart 9 (6.3) 0 – 15.3 12,966.47 (6,656.49) 6.7 (1.9) Disease Pericardial Disease 3 (2.1) 0 – 11.1 5,968.67 (1,542.23) 11 (2.7) Total, N 142 Overall cost/patient/day 11,470.94 (8,289.57) Mean LOS 10.1 (7.1) Table 1: Summary of primary causes and direct medical cost of HF hospitalization Results 142 participants were recruited from September to November 2022. 51.4% were females, and the overall mean age was 54 (SD 20). Cor pulmonale (CP) was the leading primary cause, 41 (28.9%), then dilated cardiomyopathy (DCM), 37 (26.1%), rheumatic heart disease (RHD), 28 (19.7%), hypertensive heart disease (HHD), 24 (16.9%), ischaemic heart disease (IHD), 9 (6.3%) and pericardial disease (PD) 3 (2.1%). Overall direct cost of HF hospitalization was
RkJQdWJsaXNoZXIy NDIzNzc=