Objective To further the understanding of the factors influencing outcome following rheumatic heart disease (RHD) related mitral valve surgery, which globally remains an important cause of heart disease and a particular problem in Indigenous Australians.
Methods The Australian Cardiac Surgery Database was utilised to assess outcomes following mitral valve repair and replacement for RHD and non-RHD valve disease. The association with aetiology, demographics, comorbidities, preoperative status and operative procedure was evaluated.
Results Mitral valve repairs and replacements undertaken in Australia were analysed from 119 and 1078 RHD surgical procedures and 3279 and 2400 non-RHD procedures, respectively. RHD mitral valve repair, compared with replacement, resulted in a slightly shorter hospital stay and more reoperation for valve dysfunction, but no difference in 30-day survival. In unadjusted survival analysis to 5 years, RHD mitral valve repair and replacement were no different (HR 0.86, 95% CI 0.4 to 1.7), non-RHD repair was superior to replacement (HR 1.7, 95% CI 1.4 to 2.0), RHD and non-RHD repair were no different (HR 0.9, 95% CI 0.5 to 1.7), and RHD replacement was superior to non-RHD (HR 1.5, 95% CI 1.2 to 1.9). None of these differences persisted in adjusted analyses and there was no difference in long-term survival for Indigenous Australians.
Conclusion In this large prospective cohort study we have demonstrated that adjusted long-term survival following RHD mitral valve repair surgery in Australia is no different to replacement and no different to non-RHD. Interpretation of valve surgery outcome requires careful consideration of patient factors that may also influence survival.
- cardiac surgery
- valve surgery
- valvular disease
- mitral regurgitation
- mitral stenosis
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Contributors EAR performed the statistical analysis and drafted the manuscript. LT assisted with acquisition of data and analysis. RAB, JSB, AB and RT helped with revision of the manuscript. CMR assisted with acquisition of data and helped with revision of the manuscript. WW conceived of the study and participated in its design and coordination and helped with revision of the manuscript. GPM conceived of the study, participated in the design of the study, assisted with the statistical analysis and interpretation, and helped to draft the manuscript. All authors read and approved the final manuscript.
Competing interests None declared.
Patient consent Opt-out consent was given at the time of surgery for data collection for a national database with the explanation that the data were to collate the activities and outcomes of participating units and give an overview of the patients who underwent surgery, the types of surgery performed, complications and other details relating to risk and the outcomes of cardiac surgery. This de-identified database was used for this research.
Ethics approval Monash University.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data were from Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) National Cardiac Surgery Database, an Australia-wide voluntary registry for the prospective collection and analysis of the results of cardiac surgery. Access to this data is via written application to the administrators at Monash University, Melbourne Australia with ethical approval.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.