Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2015

Open Access 01-12-2015 | Research article

A review of outcome following valve surgery for rheumatic heart disease in Australia

Authors: E. Anne Russell, Lavinia Tran, Robert A. Baker, Jayme S. Bennetts, Alex Brown, Christopher M. Reid, Robert Tam, Warren F. Walsh, Graeme P. Maguire

Published in: BMC Cardiovascular Disorders | Issue 1/2015

Login to get access

Abstract

Background

Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing outcome following surgery for RHD.

Methods

The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to assess outcomes following surgical procedures for RHD and non-RHD valvular disease. The association with demographics, co-morbidities, pre-operative status, valve(s) affected and operative procedure was evaluated.

Results

Outcome of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients had longer ventilation, experienced fewer strokes and had more readmissions to hospital and anticoagulant complications. Mortality following RHD surgery at 30 days was 3.1 % (95 % CI 2.2 – 4.3), 5 years 15.3 % (11.7 – 19.5) and 10 years 25.0 % (10.7 – 44.9). Mortality following non-RHD surgery at 30 days was 4.3 % (95 % CI 3.9 - 4.6), 5 years 17.6 % (16.4 - 18.9) and 10 years 39.4 % (33.0 - 46.1). Factors independently associated with poorer longer term survival following RHD surgery included older age (OR1.03/additional year, 95 % CI 1.01 – 1.05), concomitant diabetes (OR 1.7, 95 % CI 1.1 – 2.5) and chronic kidney disease (1.9, 1.2 – 2.9), longer invasive ventilation time (OR 1.7 if greater than median value, 1.1– 2.9) and prolonged stay in hospital (1.02/additional day, 1.01 – 1.03). Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians.

Conclusion

In a large prospective cohort study we have demonstrated survival following RHD valve surgery in Australia is comparable to earlier studies. Patients with diabetes and chronic kidney disease, were at particular risk of poorer long-term survival. Unlike earlier studies we did not find pre-existing atrial fibrillation, being an Indigenous Australian or the nature of the underlying valve lesion were independent predictors of survival.
Literature
1.
Carapetis J, Steer A, Mulholland E, Weber M. The global burden of group a streptococcal diseases. Lancet Infect Dis. 2005;5(11):685–94.PubMedCrossRef
2.
Zuhlke L, Watkins D, Engel ME. Incidence, prevalence and outcomes of rheumatic heart disease in South Africa: a systematic review protocol. BMJ Open. 2014;4(6):e004844.PubMedPubMedCentralCrossRef
3.
Remenyi B, Carapetis J, Wyber R, Taubert K, Mayosi BM. Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol. 2013;10(5):284–92.PubMedCrossRef
4.
Wyber R, Grainger Gasser A, Thompson D, Kennedy D, Johnson T, Taubert K, et al. Tools for Implementing RHD Control Programmes (TIPS) Handbook. Perth Australia: World Heart Federation and RhEACH; 2014.
5.
Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline. Nat Rev Cardiol. 2012;9:297–309.PubMedCrossRef
6.
Roberts K, Maguire G, Brown A, Atkinson D, Reményi B, Wheaton G, et al. Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. Circulation. 2014;129(19):1953–61.PubMedCrossRef
7.
Mathur S, Moon L, S L. Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment. Canberra: Australian Institute of Health and Welfare; 2006.
8.
Yau TM, El-Ghoneimi YA, Armstrong S, Ivanov J, David TE. Mitral valve repair and replacement for rheumatic disease. J Thorac Cardiovasc Surg. 2000;119(1):53–60.PubMedCrossRef
9.
Bernal JM, Ponton A, Diaz B, Llorca J, Garcia I, Sarralde A, et al. Surgery for rheumatic tricuspid valve disease: a 30-year experience. J Thorac Cardiovasc Surg. 2008;136(2):476–81.PubMedCrossRef
10.
Sarralde J, Bernal J, Llorca J, Ponton A, Diez-Solorzano L, Gimenez-Rico J, et al. Repair of rheumatic tricuspid valve disease: predictors of very long-term mortality and reoperation. Ann Thorac Surg. 2010;90(2):503–8.PubMedCrossRef
11.
Kim JB, Kim HJ, Moon DH, Jung SH, Choo SJ, Chung CH, et al. Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg. 2010;37(5):1039–46.PubMedCrossRef
12.
Choudhary SK, Talwar S, Dubey B, Chopra A, Saxena A, Kumar AS. Mitral valve repair in a predominantly rheumatic population. Long-term results. Tex Heart Inst J. 2001;28(1):8–15.PubMedPubMedCentral
13.
Talwar S, Rajesh MR, Subramanian A, Saxena A, Kumar AS. Mitral valve repair in children with rheumatic heart disease. J Thorac Cardiovasc Surg. 2005;129(4):875–9.PubMedCrossRef
14.
Akay TH, Gultekin B, Ozkan S, Aslim E, Saritas B, Sezgin A, et al. Triple-valve procedures: impact of risk factors on midterm in a rheumatic population. Ann Thorac Surg. 2006;82(5):1729–34.PubMedCrossRef
15.
Bozbuga N, Erentug V, Kirali K, Akinci E, Isik O, Yakut C. Midterm results of aortic valve repair with the pericardial cusp extension technique in rheumatic valve disease. Ann Thorac Surg. 2004;77(4):1272–6.PubMedCrossRef
16.
Lehman SJ, Baker RA, Aylward PE, Knight JL, Chew DP. Outcomes of cardiac surgery in Indigenous Australians. Med J Aust. 2009;190(10):588–93.PubMed
17.
De Santo LS, Romano G, Della Corte A, Tizzano F, Petraio A, Amarelli C, et al. Mitral mechanical replacement in young rheumatic women: analysis of long-term survival, valve-related complications, and pregnancy outcomes over a 3707-patient-year follow-up. J Thorac Cardiovasc Surg. 2005;130(1):13–9.PubMedCrossRef
18.
Carapetis J. Rheumatic Fever. In: Cohen J, Powderly W, Berkley S, Calandra T, Clumeck N, Finch R, et al., editors. Kumar: Robbins and Cotran Pathologic Basis of Disease, Professional Edition. 1. 8th ed. Philadelphia, PA: Saunders Elsevier; 2010.
19.
Edwin F, Aniteye E, Tettey M, Tamatey M, Frimpong-Boateng K. Outcome of left heart mechanical valve replacement in West African children - A 15-year retrospective study. J Cardiothorac Surg. 2011;6:57.PubMedPubMedCentralCrossRef
20.
Gupta A, Gharde P, Kumar AS. Anterior mitral leaflet length: predictor for mitral valve repair in a rheumatic population. Ann Thorac Surg. 2010;90(6):1930–3.PubMedCrossRef
21.
Lim E, Barlow CW, Hosseinpour AR, Wisbey C, Wilson K, Pidgeon W, et al. Influence of atrial fibrillation on outcome following mitral valve repair. Circulation. 2001;104(12 Suppl 1):I59–63.PubMedCrossRef
22.
Bisno A, Butchart E, Ganguly N, Ghebrehiwet T, Lue H, Kaplan E, et al. Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation 29 October — 1 November 2001. Geneva, Switzerland: WHO; 2004.
23.
Maguire GP, Carapetis JR, Walsh WF, Brown AD. The future of acute rheumatic fever and rheumatic heart disease in Australia. Med J Aust. 2012;197(3):133–4.PubMedCrossRef
24.
Bonow R, Carabello B, Chatterjee K, de Leon JA, Faxon D, Freed M, et al. Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Valvular Heart Disease). Circulation. 2008;118:e523–661.PubMedCrossRef
25.
RHDAustralia (ARF/RHD writing group) National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. 2012. Darwin, NT, Australia: Menzies School of Health Research; 2012.
26.
Alizzi AM, Knight JL, Tully PJ. Surgical challenges in rheumatic heart disease in the Australian indigenous population. Heart Lung Circ. 2010;19(5–6):295–8.PubMedCrossRef
27.
Wisenbaugh T, Skudicky D, Sareli P. Prediction of outcome after valve replacement for rheumatic mitral regurgitation in the era of chordal preservation. Circulation. 1994;89(1):191–7.PubMedCrossRef
28.
Poveda JJ, Bernal JM, Matorras P, Hernando JP, Oliva MJ, Ochoteco A, et al. Tricuspid valve replacement in rheumatic disease: preoperative predictors of hospital mortality. J Heart Valve Dis. 1996;5(1):26–30.PubMed
29.
Skoularigis J, Sinovich V, Joubert G, Sareli P. Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation. Circulation. 1994;90(5 Pt 2):Ii167–74.PubMed
30.
McLean A, Waters M, Spencer E, Hadfield C. Experience with cardiac valve operations in Cape York Peninsula and the Torres Strait Islands, Australia. Med J Aust. 2007;186(11):560–3.PubMed
31.
32.
ANZSCTS. National Cardiac Surgery Database Program, Standard Operating Procedures Manual v1.1. Melbourne: CCRE, Monash University; 2012.
33.
Russell E, Tran L, Baker RA, Bennetts J, Brown A, Reid C, et al. Valve surgery for rheumatic heart disease in Australia. BMC Cardiovascular Disorders. 2014;14(134). doi: 10.1186/1471-2261-14-134.
34.
Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS) Remoteness Areas classification 2011 - all of Australia. Canberra, ACT, Australia: Australian Bureau of Statistics; 2013.
35.
Levey A, Bosch J, Lewis J, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461–70.PubMedCrossRef
36.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.PubMedPubMedCentralCrossRef
37.
The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston Mass: Little, Brown & Co; 1994.
38.
39.
Australian Institute of Health & Welfare 2013. Rheumatic heart disease and acute rheumatic fever in Australia: 1996–2012. Cardiovascular disease series. Cat. no. CVD 60. In: AIHW, editor. Canbera: AIHW; 2013.
40.
Ribeiro A, Wender O, de Almeida AS, Soarez L, Picon P. Comparison of clinical outcomes in patients undergoing mitral valve replacement with mechanical or biological substitutes: a 20 years cohort. BMC Cardiovasc Disord. 2014;14(1):146.PubMedPubMedCentralCrossRef
41.
Dillon J, Yakub MA, Kong PK, Ramli MF, Jaffar N, Gaffar IF. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: Is repair for “burnt-out” rheumatic disease still inferior to repair for degenerative disease in the current era? J Thorac Cardiovasc Surg. 2014;149(3):771–9.PubMedCrossRef
42.
Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA. 2014;312(13):1323–9.PubMedCrossRef
43.
Rémond MGW, Severin KL, Hodder Y, Martin J, Nelson C, Atkinson D, et al. Variability in disease burden and management of rheumatic fever and rheumatic heart disease in two regions of tropical Australia. Intern Med J. 2013;43(4):386–93.PubMedCrossRef
44.
Chang BC, Lim SH, Yi G, Hong YS, Lee S, Yoo KJ, et al. Long-term clinical results of tricuspid valve replacement. Ann Thorac Surg. 2006;81(4):1317–23. discussion 23–4.PubMedCrossRef
45.
Iscan ZH, Vural KM, Bahar I, Mavioglu L, Saritas A. What to expect after tricuspid valve replacement? Long-term results. Eur J Cardiothorac Surg. 2007;32(2):296–300.PubMedCrossRef
46.
Filsoufi F, Anyanwu AC, Salzberg SP, Frankel T, Cohn LH, Adams DH. Long-term outcomes of tricuspid valve replacement in the current era. Ann Thorac Surg. 2005;80(3):845–50.PubMedCrossRef
47.
Galloway AC, Colvin SB, Baumann FG, Grossi EA, Ribakove GH, Harty S, et al. A comparison of mitral valve reconstruction with mitral valve replacement: intermediate-term results. Ann Thorac Surg. 1989;47(5):655–62.PubMedCrossRef
48.
Wu MH, Lue HC, Wang JK, Wu JM. Implications of mitral valve prolapse in children with rheumatic mitral regurgitation. J Am Coll Cardiol. 1994;23(5):1199–203.PubMedCrossRef
49.
Borer JS, Bonow RO. Contemporary approach to aortic and mitral regurgitation. Circulation. 2003;108(20):2432–8.PubMedCrossRef
50.
Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg. 2007;31(2):267–75.PubMedCrossRef
51.
Kalangos A, Myers PO. Aortic cusp extension for surgical correction of rheumatic aortic valve insufficiency in children. World J Pediatric & Congenital Heart Surgery. 2013;4(4):385–91.CrossRef
52.
Talwar S, Saikrishna C, Saxena A, Kumar AS. Aortic valve repair for rheumatic aortic valve disease. Ann Thorac Surg. 2005;79(6):1921–5.PubMedCrossRef
53.
Bhandari S, Subramanyam K, Trehan N. Valvular heart disease: diagnosis and management. J Assoc Physicians India. 2007;55:575–84.PubMed
54.
Bakir I, Onan B, Onan IS, Gul M, Uslu N. Is rheumatic mitral valve repair still a feasible alternative?: indications, technique, and results. Tex Heart Inst J. 2013;40(2):163–9.PubMedPubMedCentral
55.
White H, Walsh W, Brown A, Riddell T, Tonkin A, Jeremy R, et al. Rheumatic heart disease in indigenous populations. Heart Lung Circ. 2010;19(5–6):273–81.PubMedCrossRef
56.
Couzos S, Carapetis J. Rheumatic Fever. In: Couzos M, Murray R, editors. Aboriginal Primary Health Care: An Evidence-Based Approach. 2nd ed. Melbourne: Oxford University Press; 2003.
57.
58.
Enriquez-Sarano M, Tajik AJ, Schaff HV, Orszulak TA, Bailey KR, Frye RL. Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation. 1994;90(2):830–7.PubMedCrossRef
59.
Ratnatunga CP, Edwards MB, Dore CJ, Taylor KM. Tricuspid valve replacement: UK Heart Valve Registry mid-term results comparing mechanical and biological prostheses. Ann Thorac Surg. 1998;66(6):1940–7.PubMedCrossRef
60.
Essop MR, Nkomo VT. Rheumatic and Nonrheumatic Valvular Heart Disease: Epidemiology, Management, and Prevention in Africa. Circulation. 2005;112(23):3584–91.PubMedCrossRef
61.
Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc. 2001;76(5):467–75.PubMedCrossRef
62.
Qureshi W, Soliman EZ, Solomon SD, Alonso A, Arking DE, Shah A, et al. Risk factors for atrial fibrillation in patients with normal versus dilated left atrium (from the atherosclerosis risk in communities study). Am J Cardiol. 2014;114(9):1368–72.PubMedPubMedCentralCrossRef
63.
Platt AB, Localio AR, Brensinger CM, Cruess DG, Christie JD, Gross R, et al. Risk factors for nonadherence to warfarin: results from the IN-RANGE study. Pharmacoepidemiol Drug Saf. 2008;17(9):853–60.PubMedPubMedCentralCrossRef
64.
Mincham CM, Mak DB, Plant AJ. The quality of management of rheumatic fever/ heart disease in the Kimberley. Aust N Z J Public Health. 2002;26(5):417–20.PubMedCrossRef
65.
Corciova FC, Corciova C, Georgescu CA, Enache M, Anghel D, Bartos O, et al. Echocardiographic predictors of adverse short-term outcomes after heart surgery in patients with mitral regurgitation and pulmonary hypertension. Heart Surg Forum. 2012;15(3):E127–32.PubMedCrossRef
66.
Kusunose K, Popovic ZB, Motoki H, Marwick TH. Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation. Circ Cardiovasc Imaging. 2013;6(2):167–76.PubMedCrossRef
67.
Magne J, Lancellotti P, Piérard LA. Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation. Circulation. 2010;122(1):33–41.PubMedCrossRef
68.
Nagelkerke NJD. A note on a general definition of the coefficient of determination. Biometrika. 1991;78(3):691–2.CrossRef
Metadata
Title
A review of outcome following valve surgery for rheumatic heart disease in Australia
Authors
E. Anne Russell
Lavinia Tran
Robert A. Baker
Jayme S. Bennetts
Alex Brown
Christopher M. Reid
Robert Tam
Warren F. Walsh
Graeme P. Maguire
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2015
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-015-0094-1

Other articles of this Issue 1/2015

BMC Cardiovascular Disorders 1/2015 Go to the issue

Research article

Molecular mechanisms behind progressing chronic inflammatory dilated cardiomyopathy

Research article

Elevated expression of periostin in diabetic cardiomyopathy and the effect of valsartan

Research article

The rs1803274 polymorphism of the BCHE gene is associated with an increased risk of coronary in-stent restenosis

Case report

Recurrent Tako-Tsubo cardiomyopathy (TTC) in a pre-menopausal woman: late sequelae of a traumatic event?

Research article

Two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation

Research article

Effectiveness of combination therapy with nifedipine GITS: a prospective, 12-week observational study (AdADOSE)

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits