ArticleJTCVS structural and endovascular2026
Outcomes, survival, mortality, and major adverse events in aortic valve replacement surgeries in Africa: A systematic review and meta-analysis.
Article in JTCVS structural and endovascular, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Aortic valve replacement (AVR) is the definitive treatment for severe aortic valve disease, yet outcome data from Africa remain scarce. This systematic review and meta-analysis assessed survival, mortality, and major adverse events after AVR across Africa. Methods: Adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched PubMed, Embase, and Web of Science for studies reporting AVR outcomes in African populations, covering randomized trials, cohort studies, case series, and case reports. Subgroup analyses were conducted by AVR modality: surgical aortic valve replacement (SAVR), minimally invasive surgery (MICS), and transcatheter aortic valve implantation. Study quality was assessed using the Cochrane Risk of Bias tool 2 and the Newcastle-Ottawa Scale. Outcomes included survival, mortality, echocardiographic improvements, and valve- or procedure-related complications. Results: Of 2547 studies screened, 21 studies involving 1303 patients across 6 African countries were included; 15 (71.4%) studies were from Egypt. Mean age was 60.4 years; 43.3% were female. Aortic stenosis (70.4%) and regurgitation (64.0%) predominated. Modalities included SAVR (45.1%), minimally invasive surgery (27.8%), and transcatheter aortic valve implantation (27.1%). Technical success rate was high (97.5%-100%). Complications included arrhythmias (16.0%), postoperative bleeding (15.0%), paravalvular leak (5.0%), pacemaker requirement (6.0%), stroke (5.0%), and myocardial infarction (3.0%). Reoperation rate was 4.4%. Thirty-day mortality was 5.0% (95% CI. 3.1%-8.1%), with 1-year and 5-year survival of 93.2% and 91.0%, respectively. Conclusions: AVR outcomes in Africa show favorable success and survival rate although below optimal benchmarks despite resource constraints. However, results are not generalizable continent-wide, given the heavy geographic skew. Complications including arrhythmias and postoperative bleeding necessitate enhanced perioperative protocols.
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