Repair of Rheumatic Tricuspid Valve Disease: Predictors of Very Long-Term Mortality and Reoperation

Sarralde, J.A.; Bernal, José Manuel López; Llorca, Javier; Pontón, Alejandro; Díez-Solórzano, L.; Giménez-Rico, Juan Ramón Sanz; Revuelta, José M.

doi:10.1016/j.athoracsur.2010.03.105

Cited by 30 publications

(19 citation statements)

References 19 publications

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“…Not all valves, however, are suitable for repair [ 38 ] and repaired valves have an increased risk of early reoperation [ 38 , 39 ]. A key factor in increasing the chance of successful mitral valve repair is likely to be earlier referral prior to the onset of valvular fibrosis and calcification which may reduce the chance of successful repair [ 40 ] and concentrating RHD surgical management in centres with greater experience in this area.…”

Section: Discussionmentioning

confidence: 99%

A review of valve surgery for rheumatic heart disease in Australia

Russell

Tran

Baker

et al. 2014

BMC Cardiovasc Disord

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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.

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Section: Discussionmentioning

confidence: 99%

A review of valve surgery for rheumatic heart disease in Australia

Russell

Tran

Baker

et al. 2014

BMC Cardiovasc Disord

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“…Therefore, in this study we confirmed that the outcome of patients with significant TR has adverse effect on survival and quality of life of the patients. Surgical management for functional TR can be easily performed; however, the incidence of postoperative morbidity and mortality are high.On the other hand, repair of the tricuspid valve in patients with rheumatic valve disease can be performed with acceptable early results, but progression of rheumatic disease is associated with a high incidence of valvular dysfunction, and mortality in the long term ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Severe Tricuspid Regurgitation on Long Term Survival

Sadeghpour¹,

Hassanzadeh²,

Kyavar³

et al. 2013

Res Cardiovasc Med

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Background:Tricuspid regurgitation (TR) is a common echocardiographic finding, which often accompanies left sided valve disease. Data on mortality and morbidity in patients with severe TR are limited.Objectives:We sought to assess the outcome of patients with severe TR with the hypothesis that significant TR adversely impacts quality of life and survival, independent of pulmonary artery pressure (PAP) and left ventricular ejection fraction (LVEF).Materials and Methods:Between 2002 and 2012, 358 consecutive patients (mean age of 54.67± 13.25years, 75.5% female) with severe TR based on history and transthoracic echocardiography (TTE) were enrolled. Patients with severe left sided valvular heart disease and congenital heart disease were excluded. The prevalence of heart failure symptoms, rehospitalization, and duration of hospitalization were evaluated. Survival was calculated according Kaplan Meier curve analysis.Results:Heart failure (50%) was the most cause of death. Mean years of survival from diagnosis of severe TR was 4.35±3.66, and mean years of survival from onset of symptom was 2.28±1.40. Ninety cases (25.1%) were admitted due to heart failure and through mean of 1.9±0.8 year- follow up (6-32month), 14% of all patients and 36.8% of patients with right heart failure rehospitalized. Atrial fibrillation was reported in 70.5% of patients.Conclusions:There is a significant increased incidence of mortality, prolonged hospitalization, and rehospitalization in symptomatic patients with severe TR. Therefore, we recommend more aggressive approach toward TV repair or replacement in these patients regardless of PAP and systolic function.

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“…Surgical intervention remains an important treatment modality for those with more severe forms of RHD, yet disparities exist in access to and outcomes following RHD surgery [ 7 ]. Factors which have been identified as being associated with outcomes following valve surgery in patients with RHD-related valve disease include age [ 8 – 11 ], pre-operative clinical status [ 8 – 10 , 12 – 15 ], pre-existing atrial fibrillation (AF) [ 13 , 16 , 17 ], left ventricular function [ 12 – 14 , 18 , 19 ] and the nature of the underlying valve lesion [ 10 , 12 , 13 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

A review of outcome following valve surgery for rheumatic heart disease in Australia

Russell

Tran

Baker

et al. 2015

BMC Cardiovasc Disord

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BackgroundGlobally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing outcome following surgery for RHD.MethodsThe Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to assess outcomes following surgical procedures for RHD and non-RHD valvular disease. The association with demographics, co-morbidities, pre-operative status, valve(s) affected and operative procedure was evaluated.ResultsOutcome of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients had longer ventilation, experienced fewer strokes and had more readmissions to hospital and anticoagulant complications. Mortality following RHD surgery at 30 days was 3.1 % (95 % CI 2.2 – 4.3), 5 years 15.3 % (11.7 – 19.5) and 10 years 25.0 % (10.7 – 44.9). Mortality following non-RHD surgery at 30 days was 4.3 % (95 % CI 3.9 - 4.6), 5 years 17.6 % (16.4 - 18.9) and 10 years 39.4 % (33.0 - 46.1). Factors independently associated with poorer longer term survival following RHD surgery included older age (OR1.03/additional year, 95 % CI 1.01 – 1.05), concomitant diabetes (OR 1.7, 95 % CI 1.1 – 2.5) and chronic kidney disease (1.9, 1.2 – 2.9), longer invasive ventilation time (OR 1.7 if greater than median value, 1.1– 2.9) and prolonged stay in hospital (1.02/additional day, 1.01 – 1.03). Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians.ConclusionIn a large prospective cohort study we have demonstrated survival following RHD valve surgery in Australia is comparable to earlier studies. Patients with diabetes and chronic kidney disease, were at particular risk of poorer long-term survival. Unlike earlier studies we did not find pre-existing atrial fibrillation, being an Indigenous Australian or the nature of the underlying valve lesion were independent predictors of survival.

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Repair of Rheumatic Tricuspid Valve Disease: Predictors of Very Long-Term Mortality and Reoperation

Cited by 30 publications

References 19 publications

A review of valve surgery for rheumatic heart disease in Australia

A review of valve surgery for rheumatic heart disease in Australia

Impact of Severe Tricuspid Regurgitation on Long Term Survival

A review of outcome following valve surgery for rheumatic heart disease in Australia

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