A review of valve surgery for rheumatic heart disease in Australia

Abstract

BackgroundGlobally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects older non-Indigenous Australians and Aboriginal Australians and/or Torres Strait Islander peoples. Factors associated with the choice of treatment for advanced RHD remain variable and poorly understood.MethodsThe Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. Demographics, co-morbidities, pre-operative status and valve(s) affected were collated and associations with management assessed.ResultsSurgical management of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients were younger, more likely to be female and Indigenous Australian, to have atrial fibrillation (AF) and previous percutaneous balloon valvuloplasty (PBV). Surgery was performed on one valve in 64.5%, two valves in 30.0% and three valves in 5.5%. Factors associated with receipt of mechanical valves in RHD were AF (OR 2.69) and previous PBV (OR 1.98) and valve surgery (OR 3.12). Predictors of valve repair included being Indigenous (OR 3.84) and having fewer valves requiring surgery (OR 0.10). Overall there was a significant increase in the use of mitral bioprosthetic valves over time.ConclusionsRHD valve surgery is more common in young, female and Indigenous patients. The use of bioprosthetic valves in RHD is increasing. Given many patients are female and younger, the choice of valve surgery and need for anticoagulation has implications for future management of RHD and related morbidity, pregnancy and lifestyle plans.

Outcomes after mitral valve surgery for rheumatic heart disease

“…This is consistent with these patients having more advanced mitral RHD which are therefore less amenable to repair. The prevalence of preoperative AF is particularly high in patients with valvular disease due to RHD,12 with its occurrence most common in mitral stenosis 30. Undertaking RHD mitral valve surgery before the onset of AF could provide greater therapeutic choice and optimise the opportunity for repair being undertaken.…”

“…The nature and breadth of this registry has been reported elsewhere 12. Briefly, it collects data from 25 Australian hospitals regarding patients who have undergone cardiac surgery, the types of surgery performed and early (30 day) complications,12 14 15 and links this with long-term survival data.…”

“…Given the greater burden of RHD-related valve disease in Indigenous Australians, who are also more likely to reside in remote locations,12 this study also aimed to examine specifically whether the management and outcome of RHD-related mitral valve disease was different in this particular group.…”

Outcome following valve surgery in Australia: development of an enhanced database module

“…Whilst now rare in high income countries [2, 3], it remains a condition of global health importance and an important cause of preventable heart disease. In Australia RHD particularly affects Aboriginal and/or Torres Strait Islander peoples (Indigenous Australians) and older non-Indigenous Australians [4, 5]. …”

“…We have previously analysed data [6] from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) National Cardiac Surgery Database [7] and have identified differences in surgical management for RHD and non­RHD valve disease and for Aboriginal and/or Torres Strait Islander and non­Indigenous Australian patients [5]. In addition we have been able to identify factors associated with outcomes following valve surgery for RHD and non­RHD related valve disease [5, 6, 8].…”