RT Journal Article
SR Electronic
T1 Outcomes after mitral valve surgery for rheumatic heart disease
JF Heart Asia
FD BMJ Publishing Group Ltd, British Cardiovascular Society and Asia Pacific Heart Association
SP e010916
DO 10.1136/heartasia-2017-010916
VO 9
IS 2
A1 E Anne Russell
A1 Warren F Walsh
A1 Christopher M Reid
A1 Lavinia Tran
A1 Alex Brown
A1 Jayme S Bennetts
A1 Robert A Baker
A1 Robert Tam
A1 Graeme P Maguire
YR 2017
UL http://heartasia.bmj.com/content/9/2/e010916.abstract
AB 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.