An Australian-based Outreach Program of Valve Replacement Surgery for Rheumatic Heart Disease in Fiji: Early and Late Mortality, and Major Adverse Valve-related Events, Over a 10 Year Period, 2001–2011

Abstract

Background: Fiji has one of the world's highest rates of rheumatic heart disease (RHD). The associated valve deterioration and dysfunction results in significant mortality and morbidity. Volunteer surgical teams conduct valve replacements (VR) but rarely publish their outcomes. This study aims to evaluate the early and late mortality, and major adverse valve-related events (MAVE), after VR for RHD in Fiji, performed by the Sydney Adventist Hospital coordinated Operation Open Heart team.Methods: Patients (n = 131) were treated from 2001 to 2011. Complete data on 120 (92%) patients was extracted from medical records at hospitals (n = 7) and out-patient clinics (n = 18) and through familial network searching.Results: Patients' age at the time of surgery was 25.52 yrs (SD 11.84 range 6-52 yrs), and the majority were female (61%) and indigenous Fijian (71%). Valves replaced were isolated-mitral (53%), isolated-aortic (18%) and multiple (29%) valves. Almost all patients (97%) had a mechanical prosthesis. The median time since surgery was 2.5 years (range 0.16-10 years). The cumulative mortality rate at 30 and 60 days, and 1 and 5 years, was 1.6%, 5%, 10% and 18% respectively. The cumulative MAVE rate at 30 and 60 days, and 1 and 5 years was 8%, 8%, 18% and 27% respectively. After adjusting for age and valves being replaced, males were much less likely to die (Odds ratio .25, 95% confidence interval .08-.81).Conclusions: High level of follow-up allows accurate comparison of outcomes to developing countries and indicates comparable benefits; outcomes for women need further investigation.