Figure 2.

Percentage of patients undergoing heart valve surgery who need mitral/aortic valve interventions in LMICs versus HICs. The largely rheumatic pathology in LICs would require mitral valve interventions in almost all patients presenting for surgery below the age of 30 (9,59) and in three quarters of urban middle-aged patients in MICs (60). Although aortic valve surgery is still required in half of all patients with RHD, 9 out of 10 of these also need mitral valve replacement/repair (59,60). In contrast, in the mostly elderly patients of HICs with their typically degenerative diseases, the aortic valve is the primarily affected heart valve—in a majority without co-affecting the mitral valve (56-58). LMICs, low- and middle-income countries; HICs, high-income countries; LICs, low-income countries; RHD, rheumatic heart disease; AV, aortic valve; MV, mitral valve.