Critical analysis of rheumatic mitral valve surgery outcomes in central South Africa
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Date
2021-10
Authors
De-huis, Thabo J.
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction: Rheumatic heart disease (RHD) is still an important cause of acquired heart disease affecting children and young adults from poor socio-economic backgrounds. The most common presentation of RHD is mitral valve disease requiring surgical intervention. The study aim was firstly to describe peri-operative risk factors, procedures performed and surgical outcomes after mitral valve surgery for RHD in Central South Africa. Secondly, to compare these results in patients presenting with mitral regurgitation to those presenting with mitral stenosis and mixed mitral valve disease. Methods: Patients undergoing mitral valve surgery for RHD, with or without concomitant tricuspid valve repair between January 2009 and December 2019 were identified from the departmental database. The lesions were grouped into mitral stenosis (MS), mitral regurgitation (MR), and mixed mitral (MX) disease. Statistical analyses was performed using the IBM SPSS program, version 26.0. A p-value of 0.05 or less was considered statistically significant. Results: A total of 242 patients were included in the study of which 75.2% (n=182) were female. Black patients represented 74.4% (n=180), whites 13.6% (n=33) with Asian and mixed races at 12% (n=29). The mean age of the study population was 43.7 years. Distribution of patients according to the lesions was 25.6% (n=62) for MS, 45.0% (n=109) for MR and 29.3% (n=71) for MX disease. Patients presenting in NYHA status III and IV formed 44% of the MR group and 44% of the MS group and for 28% for the MX group. Calculated EuroSCORE > 5 was 29.4% (n=18) in the MS group, 29% (n=32) in the MR group, and 9.9% (n=7) in the MR group. For the MS group, 96.7% (n=60) had mitral valve replacement and only 2.8% (n=2) were repaired (valvotomy); whilst in the MR and MX groups the replacement vs repair rate was 90.3% (n=93) and 94% (n=63) vs 9.7% (n=10) and 5.6% (n=4) respectively. The MS group had the highest number of concomitant tricuspid valve repair at 58.0% (n=36) as compared to MR (38.5%) and MX (35.2%) groups. There was no statistical difference across the groups with regards to the post-operative stroke rate (1%) as well as the rate of in-hospital complications (14%). In-hospital mortality for the entire cohort was 3.8% (n=9), with 4.8% (n=3) for the MS, 3.7% (n=4) in the MR group and 2.8% (n=2) in the MX group. Of the 242 patients in the study 82 did not have their follow up at the UAH clinic. For the 160 patients followed up at UAH clinic, the median follow-up time was 2.68 years, with 35 patients having had follow-up visits > 5 years. Conclusion: Patients received mitral valve surgery had RHD and were young females from poor socio-economic backgrounds with an average age in the 4th decade of life. MR was the most common lesion with replacement being the most performed operation in our unit. The post-operative complications rate as well as the in-hospital mortality were comparable to the published literature.
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Keywords
Dissertation (M.Med. (Cardiothoracic Surgery))--University of the Free State, 2021, Rheumatic heart disease, Mitral stenosis, Regurgitation, Mixed valve disease, Bioprosthesis, Mitral valve repair, Balloon mitral valvotomy, Mitral replacement, Tricuspid valve, In-hospital mortality