Surgical mitral valve replacement in rheumatic heart disease patients resulted in similar one-year mortality compared to non-rheumatic patients (6.4% vs 13.8%; HR 0.80; 95% CI 0.53-1.21; p=0.288).
Cohort (n=435)
Yes
Does surgical mitral valve replacement in rheumatic heart disease patients yield similar one-year mortality compared to non-rheumatic heart disease patients and across different center volumes?
Surgical mitral valve replacement for rheumatic heart disease patients in a high-income country demonstrates effective outcomes, with one-year mortality comparable to non-rheumatic patients and consistent across different hospital volumes.
Effect estimate: HR 0.80 (95% CI 0.53-1.21)
Absolute Event Rate: 6.4% vs 13.8%
p-value: p=0.288
Abstract 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.
Wilde et al. (Sat,) conducted a cohort in Rheumatic heart disease requiring mitral valve replacement (n=435). Surgical mitral valve replacement (MVR) vs. Non-rheumatic heart disease MVR patients was evaluated on One-year mortality (HR 0.80, 95% CI 0.53-1.21, p=0.288). Surgical mitral valve replacement in rheumatic heart disease patients resulted in similar one-year mortality compared to non-rheumatic patients (6.4% vs 13.8%; HR 0.80; 95% CI 0.53-1.21; p=0.288).