Current Outcomes of Valvular Surgery for Indigenous Australians With Rheumatic Heart Disease: A Single-centre Experience

Abstract

Purpose: Rheumatic heart disease (RHD) remains a problem amongst Indigenous Australians, with many presenting for surgery at a young age. Long-term outcomes of RHD surgery amongst Indigenous Australians remain unreported. Hence, this study aimed to describe outcomes of valvular surgery for RHD in Indigenous Australians at a single centre. Methods: Indigenous Australian patients with RHD and who underwent valvular surgery (n = 112) between 2008 and 2016 were reviewed. Data were prospectively collected, and follow-up was obtained fromcardiologists. Multivariate analysis was performed to determine predictors of mortality. Results: Mean age was 43±16 years (range 13–73) with 82 (73%) being females. Surgery was performed on the mitral valve in 93 (83%), aortic valve in 51 (46%), and tricuspid valve in 28 (25%) patients. In patients aged ≤50 years (n = 73), there were 45 bioprosthetic (62%) valves implanted. Operative mortality was 2.7%. Nine (8%) patients had reoperation for infective endocarditis (n = 3), bioprosthetic valve degeneration (n = 4), mechanical valve thrombus (n = 1), and progression of RHD in other valves (n = 1). There were 18 (16%) late deaths, and survival at 5 years was 83±4.1 (95% CI 73–89%). Risk factors for mortality were concomitant coronary artery bypass grafting (p = 0.008) and preoperative left ventricular ejection fraction (LVEF) ≤40% (p = 0.043). The mean follow-up for survivors was 5 years (2 months–9 years) with 97% of patients in New York Heart Association class I or II. Conclusions: Valvular surgery forRHD in Indigenous Australians can be performed with low operative mortality. In patients aged ≤50 years, bioprostheses were the valve of choice. Concomitant coronary artery disease and LVEF ≤40% were predictors of mortality.