E Anne Russell1,2, Warren F Walsh3, Christopher M Reid2,4, Lavinia Tran2, Alex Brown5,6, Jayme S Bennetts7,8, Robert A Baker7, Robert Tam9, Graeme P Maguire1,2. 1. Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. 2. School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 3. Department of Cardiology, Prince of Wales Hospital, Randwick, NSW, Australia. 4. School of Public Health, Curtin University, Perth, WA, Australia. 5. Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, Australia. 6. School of Population Health, University of South Australia, Adelaide, South Australia. 7. Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, Australia. 8. Department of Surgery, School of Medicine, Flinders University, Adelaide, South Australia, Australia. 9. Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Queensland, Australia.
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.
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.
Authors: Damien J LaPar; Gorav Ailawadi; James M Isbell; Ivan K Crosby; John A Kern; Jeffrey B Rich; Alan M Speir; Irving L Kron Journal: J Thorac Cardiovasc Surg Date: 2014-06-28 Impact factor: 5.209
Authors: Michael A Acker; Michael K Parides; Louis P Perrault; Alan J Moskowitz; Annetine C Gelijns; Pierre Voisine; Peter K Smith; Judy W Hung; Eugene H Blackstone; John D Puskas; Michael Argenziano; James S Gammie; Michael Mack; Deborah D Ascheim; Emilia Bagiella; Ellen G Moquete; T Bruce Ferguson; Keith A Horvath; Nancy L Geller; Marissa A Miller; Y Joseph Woo; David A D'Alessandro; Gorav Ailawadi; Francois Dagenais; Timothy J Gardner; Patrick T O'Gara; Robert E Michler; Irving L Kron Journal: N Engl J Med Date: 2013-11-18 Impact factor: 91.245
Authors: Joselyn Rwebembera; Bruno Ramos Nascimento; Neema W Minja; Sarah de Loizaga; Twalib Aliku; Luiza Pereira Afonso Dos Santos; Bruno Fernandes Galdino; Luiza Silame Corte; Vicente Rezende Silva; Andrew Young Chang; Walderez Ornelas Dutra; Maria Carmo Pereira Nunes; Andrea Zawacki Beaton Journal: Pathogens Date: 2022-01-28