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. 2014 Oct 2:14:134.
doi: 10.1186/1471-2261-14-134.

A review of valve surgery for rheumatic heart disease in Australia

Elizabeth Anne Russell, Lavinia Tran, Robert A Baker, Jayme S Bennetts, Alex Brown, Christopher Michael Reid, Robert Tam, Warren Frederick Walsh, Graeme Paul Maguire  1
Affiliations

A review of valve surgery for rheumatic heart disease in Australia

Elizabeth Anne Russell et al. BMC Cardiovasc Disord. .

Abstract

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.

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Figures

Figure 1
Figure 1
Cardiac surgical procedures collected in the ANZCTS Database between 1 August 2001 and 31 December 2012.
Figure 2
Figure 2
Number of contributing surgical centres and RHD valve procedures over time.
Figure 3
Figure 3
Changes in RHD mitral valve surgery over time, total and stratified by Indigenous status. (Numbers at the top of each column refer to the total number of procedures for that year).
Figure 4
Figure 4
Changes in RHD aortic valve surgery over time, total and stratified by Indigenous status. (Numbers in each column refer to the total valve surgeries for that year).
See this image and copyright information in PMC

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/14/134/prepub

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