The practice and results of age-based coronary study among patients 40 years and above undergoing valve surgery due to rheumatic heart disease: A cross-sectional study

Abstract

Background

Rheumatic valvular disease is the most common indication for open heart surgeries in developing countries. Western guidelines recommend preop coronary studies before valve surgery for patients above 40 years of age and that has also been the practice in patients with rheumatic valve disease. Co-existence of coronary disease among patients with rheumatic valve disease is not well studied before.

Objective

To evaluate the prevalence of Coronary artery disease among older adults (above 40 years of age) undergoing valve procedures due to rheumatic heart disease and asses the validity of age-based recommendation for preop screening among those patients.

Method

Retrospective chart review of patients with rheumatic valve disease who underwent valve surgeries between January 2017 to October 2023 at Tenwek Hospital,Kenya was done. All patients 40 years of age and above were included, patients with non rheumatic valvular diseases, patients with confirmed or symptomatic Coronary artery disease were excluded.

Results

A total of 108 patients were identified. Seventy-five (69%) patients were female, median age was 51 yrs and mitral valve replacement was the most common procedure. Ninety-eight percent had preop coronary screening study and only 2 cases of mild disease detected with the rest of them having no evidence of coronary disease.

Conclusions

This study showed that coronary artery disease is infrequent among patients with rheumatic valve disease and screening can possibly be considered only for patients with strong risk factors rather than age alone. Further study on the topic is recommended to establish strong practice guideline for this particular patient population.