Surgical Care for Rheumatic Heart Disease Patients: Insights from the Netherlands Heart Registration

Background Although rheumatic heart disease (RHD) has declined in high-income countries, migration sustains its presence. Definite therapy for RHD is surgical mitral valve replacement (MVR), but data are lacking in the Netherlands. Aim This study evaluated the overall surgical care for RHD patients with data from the Netherlands Heart Registration (NHR). Methods This prospective cohort study included RHD MVR patients from all cardiothoracic centers (n=16) in the Netherlands. RHD MVR patients aged ≤ 75 years were identified in the NHR database between 2017-2023. Baseline, admission, procedural, and outcome data were analyzed, with up to five years of follow-up. RHD patients were compared across center volumes, divided into tertiles, and with non-RHD MVR patients in the NHR database. Results Overall, 435 RHD patients were included with a mean (SD) age of 58 (12) years and 73.3% (n=319) was female. Upon admission, 77.0% (n=335) of patients had a LVEF ≥ 50.0%, 40.2% (n=175) had atrial fibrillation, and 45.3% (n=197) were highly symptomatic (NYHA III-IV). Within a median (IQR) postoperative follow-up of 2.9 (1.1-4.6) years, total uncensored mortality was 12.2% (n=53). One-year mortality was similar among RHD MVR patients in high-volume (>200 MVRs) (6.9%) and low-volume (<132 MVRs) (7.6%) centers (p=0.791). One-year mortality did not differ between RHD (6.4%) and non-RHD (13.8%) MVR patients (HR: 0.80; 95% CI 0.53-1.21; p=0.288). Conclusion These data show effective surgical care for RHD MVR patients, with similar one-year mortality rates across center volumes and compared with non-RHD MVR patients, suggesting that RHD MVR patients can be managed similarly as non-RHD MVR patients.