A review of valve surgery for rheumatic heart disease in Australia

BMC Cardiovascular Disorders

Graeme Paul Maguire¹  Warren Frederick Walsh²  Robert Tam³  Christopher Michael Reid⁴  Alex Brown⁵  Jayme S Bennetts⁷  Robert A Baker⁶  Lavinia Tran⁴  Elizabeth Anne Russell⁴ 

[1] School of Medicine, James Cook University, Cairns, Queensland, Australia;Cardiology Department, Prince of Wales Hospital, Randwick, NSW, Australia;Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia;School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;School of Population Health, University of South Australia, Adelaide, SA, Australia;Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA, Australia;Department of Surgery, School of Medicine, Flinders University, Adelaide, SA, Australia

关键词: Valve choice;    Indigenous health;    Rheumatic valve surgery;    Rheumatic heart disease;   

Others  :  1088438
DOI  :  10.1186/1471-2261-14-134

 received in 2014-08-02, accepted in 2014-09-23,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Russell et al.; licensee BioMed Central Ltd.

【 图 表 】

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