Outcomes after mitral valve surgery for rheumatic heart disease

E. Anne Russell, Warren F. Walsh, Christopher M. Reid, Lavinia Tran, Alex Brown, Jayme S Bennetts, Robert A. Baker, Robert Tam, Graeme P. Maguire

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number010916
Number of pages7
JournalHeart Asia
Volume9
Issue number2
DOIs
Publication statusPublished - 1 Jul 2017

Keywords

  • cardiac surgery
  • mitral regurgitation
  • mitral stenosis
  • valve surgery
  • valvular disease

Cite this

Russell, E. Anne ; Walsh, Warren F. ; Reid, Christopher M. ; Tran, Lavinia ; Brown, Alex ; Bennetts, Jayme S ; Baker, Robert A. ; Tam, Robert ; Maguire, Graeme P. / Outcomes after mitral valve surgery for rheumatic heart disease. In: Heart Asia. 2017 ; Vol. 9, No. 2.
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abstract = "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.",
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Outcomes after mitral valve surgery for rheumatic heart disease. / Russell, E. Anne; Walsh, Warren F.; Reid, Christopher M.; Tran, Lavinia; Brown, Alex; Bennetts, Jayme S; Baker, Robert A.; Tam, Robert; Maguire, Graeme P.

In: Heart Asia, Vol. 9, No. 2, 010916, 01.07.2017.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Outcomes after mitral valve surgery for rheumatic heart disease

AU - Russell, E. Anne

AU - Walsh, Warren F.

AU - Reid, Christopher M.

AU - Tran, Lavinia

AU - Brown, Alex

AU - Bennetts, Jayme S

AU - Baker, Robert A.

AU - Tam, Robert

AU - Maguire, Graeme P.

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N2 - 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.

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.

KW - cardiac surgery

KW - mitral regurgitation

KW - mitral stenosis

KW - valve surgery

KW - valvular disease

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U2 - 10.1136/heartasia-2017-010916

DO - 10.1136/heartasia-2017-010916

M3 - Article

VL - 9

JO - Heart Asia

JF - Heart Asia

SN - 1759-1104

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