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

Elizabeth Anne Russell,Christopher Michael Reid,Graeme Paul Maguire,Robert A Baker,Lavinia Tran,Jayme S Bennetts,Alex Brown,Robert Tam,Warren Frederick Walsh

doi:10.1186/1471-2261-14-134

Abstract

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.

Highlights

Rheumatic heart disease (RHD) remains an important cause of heart disease
We found Indigenous Australian rheumatic heart disease (RHD) patients were less likely to have associated kidney disease
Mitral and aortic valve disease remains the focus of most surgery but tricuspid valve procedures are not uncommon

Summary

Introduction

Rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it affects older non-Indigenous Australians and Aboriginal Australians and/or Torres Strait Islander peoples. Whilst RHD is rare in high income countries [3], it remains an important cause of preventable heart disease in some Indigenous populations in these countries This is likely to be explained by a combination of educational, economic and environmental disadvantage and reduced access to primary and specialist health care [4]. In some populations at risk of RHD, such as Aboriginal Australians and Torres Strait Islanders, outcomes following cardiac surgery can be inferior [8,9] despite being of younger age at time of surgery [8] This is likely to be related to factors including comorbidities [4,8,9], barriers to primary and specialist health care and the ability to achieve safe anticoagulation during long-term follow-up [10]

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