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Outcomes after mitral valve surgery for rheumatic heart disease.

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.

SUBMITTER: Russell EA

PROVIDER: S-EPMC5818046 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Outcomes after mitral valve surgery for rheumatic heart disease.

Russell E Anne EA Walsh Warren F WF Reid Christopher M CM Tran Lavinia L Brown Alex A Bennetts Jayme S JS Baker Robert A RA Tam Robert R Maguire Graeme P GP

Heart Asia 20170619 2

<h4>Objective</h4>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.<h4>Methods</h4>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, preopera ...[more]

PMID: 29467839

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Project description:BackgroundThe clinical outcome of mitral valve repair (MVP) is considerably more favorable than that of mitral valve replacement (MVR) in patients with degenerative mitral disease. However, rheumatic heart disease (RHD) is still the predominant cause of mitral valve surgery in developing countries and the advantages of MVP in RHD have still not been definitely proven. The aim of this meta-analysis was thus to evaluate the suitability of MVP in patients with RHD. Considering the difference between mechanical and biological valves, we distinguished them from each other and compared them with MVP individually.MethodsA comparison of clinical outcomes of MVP and MVR in patients with RHD was performed based on clinical trial data. Relevant articles published from January 1, 1990 until March 1, 2020 were identified in Pubmed, Cochrane Library, and China National Knowledge Infrastructure database (CNKI). Studies that lacked direct comparisons between MVP and MVR were excluded.ResultsA total of 16 studies with 8659 patients were included in the analysis. The MVP group displayed lower early and long-term mortality, and fewer valve-related events and major adverse events. However, this patient group required more reoperations compared with the MVR group. Similar results were observed after distinguishing between mechanical and bioprosthetic valves to compare MVP with MVR (mech-valves), but no statistically significant difference was identified in the reoperation rate between MVP and MVR (bio-valves). MVP was further associated with increased risk of mitral reoperation in patients undergoing concomitant aortic valve replacement (AVR) surgery but without any improved early and long-term survival.ConclusionsMVP and MVR are beneficial for patients with RHD. For skilled surgeons, MVP can be performed for some suitable patients with RHD and is preferred for elderly patients or patients with contraindications of anticoagulation. However, MVR is more appropriate when concomitant AVR is needed.

Project description:BackgroundRheumatic Heart Disease (RHD), a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression.MethodologyThis is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS) and Mitral Regurgitation (MR). Carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), total Matrix Metalloproteinase-1(MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value <0.05 was considered statistically significant.ResultsPlasma PICP and PIIINP concentrations increased significantly (p<0.01) in MS and MR subjects compared to controls but decreased gradually over a one year period post mitral valve replacement (p<0.05). In MS, PICP level and MMP-1/TIMP-1 ratio strongly correlated with mitral valve area (r?=?-0.40; r?=?0.49 respectively) and pulmonary artery systolic pressure (r?=?0.49; r?=?-0.49 respectively); while in MR they correlated with left ventricular internal diastolic (r?=?0.68; r?=?-0.48 respectively) and systolic diameters (r?=?0.65; r?=?-0.55 respectively). Receiver operating characteristic curve analysis established PICP as a better marker (AUC?=?0.95; 95% CI?=?0.91-0.99; p<0.0001). A cut-off >459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve.ConclusionsLevels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis.

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Outcomes after mitral valve surgery for rheumatic heart disease.

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Outcomes after mitral valve surgery for rheumatic heart disease.

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