Clinical Outcomes of Children Operated for Congenital Heart Diseases In Rwanda: A 14-Year Retrospective Analysis.

Abstract

Background: Cardiac surgery and catheterization services for Rwandan children suffering from congenital heart diseases (CHD) have been availed mainly due to visiting external teams and referrals abroad. However, follow-up information on patient-specific clinical outcomes is lacking. Objective: To determine types of CHD, cardiac interventions performed, and clinical outcomes among operated children in Rwanda and abroad. Methods: This retrospective cross-sectional study of clinical outcomes of children operated for CHD in Rwanda was conducted at the University Teaching Hospital of Kigali and King Faisal Hospital, Kigali. This study included all children operated for CHD between 2006 and 2020 and followed up at a tertiary care center in Rwanda irrespective of their place of surgery. Chain of Hope Belgium and Open Heart International were both organizations leading the domestic operating missions. Data were collected using a pre-coded excel sheet of study variables from patient's files and electronic records. SPSS was used for descriptive, cross-tabulations, and multivariate logistic regression statistical analysis. Results: A total of 406 children with CHD under 15 years of age at the time of surgery were included in our study. Females represented the majority at 59.1%. The presence of underweight and stunted children was 30.5% and 28.1%, respectively. Symptomatic children at time of surgery made up 41.37% of those included. PDA and VSD were the most commonly performed interventions among acyanotic CHDs while tetralogy of Fallot was predominant maong cyanotic CHD. VSD repair was the most predominant surgical procedure performed and interventional PDA closure represented the majority of cardiac catheterizations. Pleural effusion was common among operated children at 27% and the overall mortality rate was 3.7%, with septic shock as a leading cause of death among children. Intensive care unit stays above seven days, symptomatic heart failure before surgery, and being underweight were significant predictive factors of developing complications. Cardiopulmonary bypass over 60 minutes was a predictive factor of mortality among operated children.

Conclusion: Treatment of CHD in Rwandan children is still dominated by the goodwill of visiting operating missions. Overall, good clinical outcomes have been shown despite postoperative complications and death. The lack of a centralized cardiac registry results in missing crucial information among operated children.