Surgical & Interventional Management of Rheumatic Valvular Heart Disease at The Prince Charles Hospital from January 2005–December 2017

Abstract

Background: The incidence of rheumatic heart disease (RHD) in the indigenous Australian population is the highest in the world. 240 indigenous patients underwent any valve related surgical and interventional procedures at Metro North HHS from January 2005-December 2017. Of these 75 were performed for rheumatic valves at TPCH. Methods: Chart review and electronic database procedural data was analysed, with clinical follow up records, including echocardiography, being collated to identify survival and cardiac status following these interventions. Results: Rheumatic interventions were required over an age range of 10–72 years dominantly female 82%. Percutaneous mitral balloon valvuloplasty was performed in 15 patients, transcatheter aortic valve implantation in 1 patient. Surgical valve repair of 11 isolated mitral valves was achieved. Single valve replacement was done in 10 with multiple valve repair/replacements required in the remaining 38 patients. Mechanical and tissue valves were used almost equally during replacement. Valve failure due to mitral valve thrombus formation, aortic prosthetic patient mismatch, and endocarditis required 8 reoperations. One reoperation following mitral valve repair has been required to date. Pre and post procedure LVEF mean of 56% (range 33–80%) and 57% (range 28–75%) respectively. 30-days hospital survival was 100%, 5 year was 88% and 12 year was 84%. Valve function on follow up with clinical and echo data remains satisfactory. Conclusions: Mitral valve function is durable following valvuloplasty or surgical repair in RHD. Risk to survival during all forms of intervention is low. The type of systemic heart valve utilised for replacement requires close consideration of patient geography, medical access and patient compliance.