Clinical outcomes of children operated for congenital heart diseases in Rwanda: a 14-year retrospective analysis

Background

Congenital heart disease surgery and catheterization for Rwandan children has historically been accomplished with the assistance of visiting external teams and referrals abroad. However, follow-up information on patient-specific clinical outcomes is lacking.

Methods

This is a retrospective cross-sectional study of clinical outcomes among Rwandan children under 15 years of age at the time of heart surgery operated between 2006 and 2020. Data from two Rwandan teaching hospitals were collected from paper and digital patient charts.

Results

Among the 406 children included in our study, 59.1 % were female; 30.5 % and 28.1 % of the children were underweight and stunted, respectively. Tetralogy of Fallot was the most common cyanotic CHD. Of procedures, VSD repair was the most performed operation and PDA closure represented the majority of therapeutic catheterizations. Postoperatively complications such as pneumonia occurred in 6 %, residual shunt in 17 % and residual mild or greater stenosis in 41 %. The overall mortality was 3.7 %, with sepsis as the leading cause of death. Intensive care unit stay longer than seven days, symptomatic heart failure before surgery, and being underweight were significantly associated with complications. Cardiopulmonary bypass over 60 min was associated with mortality among operated children.

Conclusion

Procedural treatment of CHD in Rwandan children was predominantly accomplished by visiting missions during the study period. Of patients with sufficient clinical follow up data, survival was 96 % and complications occurred in 35 %. Nutritional compromise is a correlate of poor outcome. A centralized cardiac registry might mitigate the observed loss of clinical follow up data in 14 % of children.