Key result
MVR in RHD patients linked to ~40% lower mortality versus non-RHD MVR.
Why the study?
Surgical valve replacement 5-year mortality for RHD varies widely across countries, and an evaluation of surgical care for RHD patients in the Netherlands was lacking.
What are the survival and complication rates of mitral valve replacement in patients with rheumatic heart disease compared to non-RHD patients?
Cohort (n=435)
Yes
What are the survival and complication rates of mitral valve replacement in patients with rheumatic heart disease compared to non-RHD patients?
Absolute Event Rate: 12% vs 20%
Surgical outcomes for rheumatic heart disease patients undergoing mitral valve replacement in the Netherlands are favorable, with lower mortality compared to routine non-RHD MVR despite significant disease severity upon admission.
Supports favorable RHD MVR outcomes in Dutch centers; leaves open whether selection or care differences explain the gap.
Background Rheumatic heart disease (RHD) is the most prevalent form of heart valve disease worldwide, especially in low- and middle income countries. In high income countries, RHD has markedly decreased, although this is mitigated by migration. Definite therapy for RHD is surgical valve replacement and the related 5-year mortality differs per country (6-33%). Evaluation of surgical care for RHD patients in the Netherlands has been missing. Purpose The purpose of this study is to assess the quality of care for surgically treated RHD patients in the Netherlands with data from the Netherlands Heart Registration (NHR). Methods A retrospective cohort study was performed. Within the NHR database, surgically treated RHD patients from all Dutch cardiothoracic centers were included. RHD patients with mitral valve replacement (MVR) were identified between 2017-2023. Baseline characteristics, admission data, procedural details, and outcome data were analyzed, focusing on complications and survival. Follow-up data were available up to 5 years after surgery. Results In total, 435 RHD patients were included with a mean age of 58 (SD ± 12) years and 73.3% was female. Upon admission, 72.6% of patients had a LVEF ≥ 55.0%, 40.2% had atrial fibrillation, and 88.7% were classified into NYHA-class II-IV. Nearly half of the patients underwent multiple valve intervention (48.5%), and of all replaced valves 33.5% was replaced by a biological valve. The median length of stay was 8 (IQR: 6,12) days, and 14.9% of patients required re-intervention within 30 days due to complications. Overall, uncensored RHD related mortality was 12.2% with a 30-day mortality of 4.1%. Patients had a median survival of 2.9 (IQR: 1.1, 4.6) years. Conclusion Data from all Dutch cardiothoracic centers showed that mortality following MVR in RHD patients was lower compared to the routine non-RHD MVR (12% vs 20%) even though the functional impairment upon admission indicated significant disease severity. Despite the various risk factors, the surgical outcomes remain favorable suggesting effective surgical care for this patient group.Complications leading to re-intervention Survival curve of RHD MVR patients
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Wilde et al. (2025) conducted a cohort in Rheumatic heart disease (n=435). Mitral valve replacement vs. Routine non-RHD mitral valve replacement was evaluated on Mortality. Mitral valve replacement in rheumatic heart disease patients was associated with lower mortality compared to routine non-RHD mitral valve replacement (12% vs 20%).
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