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A review of valve surgery for rheumatic heart disease in Australia.

Russell EA, Tran L, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Walsh WF, Maguire GP - BMC Cardiovasc Disord (2014)

Bottom Line: Factors associated with the choice of treatment for advanced RHD remain variable and poorly understood.Overall there was a significant increase in the use of mitral bioprosthetic valves over time.The use of bioprosthetic valves in RHD is increasing.

View Article: PubMed Central - PubMed

Affiliation: Baker IDI Central Australia, PO Box 1294, Alice Springs, NT 0811, Australia. Graeme.Maguire@bakeridi.edu.au.

ABSTRACT

Background: Globally, 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.

Methods: The 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.

Results: Surgical 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.

Conclusions: RHD 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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Related in: MedlinePlus

Number of contributing surgical centres and RHD valve procedures over time.
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Fig2: Number of contributing surgical centres and RHD valve procedures over time.

Mentions: A subset of 17 227 surgical valve procedures with or without coronary artery bypass grafting (CABG) was included for analysis. Contributing surgical centres have increased from five in 2001 with 33 RHD valve surgeries to 26 in 2012 and 203 RHD valve surgeries (FigureĀ 2).Figure 1


A review of valve surgery for rheumatic heart disease in Australia.

Russell EA, Tran L, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Walsh WF, Maguire GP - BMC Cardiovasc Disord (2014)

Number of contributing surgical centres and RHD valve procedures over time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4196004&req=5

Fig2: Number of contributing surgical centres and RHD valve procedures over time.
Mentions: A subset of 17 227 surgical valve procedures with or without coronary artery bypass grafting (CABG) was included for analysis. Contributing surgical centres have increased from five in 2001 with 33 RHD valve surgeries to 26 in 2012 and 203 RHD valve surgeries (FigureĀ 2).Figure 1

Bottom Line: Factors associated with the choice of treatment for advanced RHD remain variable and poorly understood.Overall there was a significant increase in the use of mitral bioprosthetic valves over time.The use of bioprosthetic valves in RHD is increasing.

View Article: PubMed Central - PubMed

Affiliation: Baker IDI Central Australia, PO Box 1294, Alice Springs, NT 0811, Australia. Graeme.Maguire@bakeridi.edu.au.

ABSTRACT

Background: Globally, 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.

Methods: The 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.

Results: Surgical 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.

Conclusions: RHD 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.

Show MeSH
Related in: MedlinePlus