5th International Conference on Heart and Cardiovascular Diseases

Yonas Teferi is a Consultant Cardiothoracic Surgeon and Chief of Cardiothoracic Surgery at the AGC Tenwek Cardiothoracic Centre in Bomet County, Kenya. He is a Fellow of the College of Surgeons of Eastern, Central, and Southern Africa (FCS[ECSA]). Dr. Teferi earned his medical degree and completed his general surgical training at Addis Ababa University in Ethiopia. He subsequently pursued fellowship training in cardiothoracic surgery through the Pan-African Academy of Christian Surgeons (PAACS) at Tenwek Hospital, Kenya. His clinical practice encompasses adult and pediatric cardiac surgery, thoracic and vascular surgery, and perioperative critical care, with a particular focus on delivering high-quality care in resource-limited settings. He is deeply committed to surgical education, mentorship, and capacity building across the region. In addition to his clinical and educational roles, Dr. Teferi has authored numerous publications in peer-reviewed journals and is actively involved in the development of regional cardiothoracic surgery data registries aimed at improving outcomes, research, and quality improvement initiatives throughout sub-Saharan Africa.

Background

Atrial fibrillation (AF) is a common and serious complication of rheumatic heart disease (RHD), especially in low- and middle-income countries. Although the Cox-Maze IV (CMP-IV) procedure is considered the gold standard for surgical ablation of AF, there is limited data on its effectiveness in RHD populations from sub-Saharan Africa.

Objective(s)

This study examines the effectiveness of combined CMP-IV in restoring and maintaining sinus rhythm in patients with RHD undergoing valve surgery at Tenwek Hospital, Kenya.

Methods

In this prospective cohort study, we evaluated 44 patients with RHD and AF who underwent valve surgery combined with CMP-IV between October 2021 and February 2024. Rhythm status was assessed at discharge, 2 weeks, 3 months, 6 months, and 1 year after surgery using 12-lead electrocardiograms (ECG). Kaplan-Meier survival analysis estimated the proportion free from AF, while Cox proportional hazards modeling identified predictors of recurrence. Due to limited resources, discrete ECG time-point monitoring was utilized.

Conclusions

The CMP-IV achieved effective rhythm control in this young RHD population, despite advanced disease and limited resources, with overall freedom from AF at one year of 68%. Most recurrences occurred within 6 months. LA size and TR severity were key predictors of recurrence, emphasizing the need for early surgical referral and tailored atrial remodeling strategies. These findings support the feasibility and value of CMP-IV in RHD-endemic, resource-limited settings, while highlighting the importance of ongoing follow-up and future technical refinements to optimize outcomes.