Short- and long-term outcomes after valve replacement surgery for rheumatic heart disease in the South Pacific, conducted by a fly-in/fly-out humanitarian surgical team: A 20-year retrospective study for the years 1991 to 2011

Abstract

The majority of people undergoing valve replacement for rheumatic heart disease have good outcomes. Mortality and morbidity rates at 1 and 5 years, particularly for female patients, are cause for concern and indicate a need for evaluation of resources toward systematic long-term postoperative surveillance and medical management.

Health-related quality of life of patients after mechanical valve replacement surgery for rheumatic heart disease in a developing country

“…Additionally, compared with the early (1 year) postoperative measures, HRQoL significantly decreased in the domains of physical function, role–physical and role–emotional. As HRQoL perception is relative, the decline in these domains may be related to ‘recovery–adaptation–reality’ in that people having survived the surgery have now also experienced 2 years of living with the lifelong health management requirements associated with a mechanical valve6 19 Aspects of mechanical VR health management, in developing countries like Fiji, are often onerous and time-consuming 27. For instance, monitoring and regulating anticoagulant medication require monthly clinic visits.…”

“…The study methods have been described elsewhere,19 but briefly, all surviving and contactable OHI patients who had VR surgery for RHD in the years 1991–2009, and all patients undergoing surgery during 2010–2012, and aged 12 years or older at the time of survey, were eligible and contacted for inclusion in this study. National and Institutional Human Research Ethics Committee approval was obtained in Australia and Fiji, prior to commencement of the study.…”

Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific

“…Detailed methodology has been described elsewhere6 but is summarised herein. The design of this component was cross-sectional.…”

“…When surgical intervention is indicated, mechanical valve prostheses are more commonly implanted for reasons of durability and reduced lifetime reoperation requirements, but this also effectively exchanges one set of disease issues for those of another 1 5. Replacement of the malfunctioning valve/s normally improves quality of life and decreases medication requirements associated with a failing valve, but adds the lifelong requirement for antithrombotic management and the associated risk of severe adverse events such as stroke or haemorrhage 6 7. Currently, the only effective oral anticoagulation agent for mechanical valve prostheses are vitamin K antagonists in the form of warfarin 5 7.…”

Controlling acute rheumatic fever and rheumatic heart disease in developing countries

“…The mortality rate for patients who underwent valve replacement was 25.7%; 32.5% of deaths occurred within 90 days of the operation. The authors suggest greater collaboration between the surgical team and local health staff, and enhanced support for patients, including education and reminders for follow up appointments would improve patient outcomes [82].…”