Key result
Bioprosthetic valves account for 61% of replacements in rheumatic heart disease, driven by physician preference.
Why the study?
Factors influencing prosthetic heart valve choice, knowledge of anticoagulation, and subsequent patient experience in rheumatic heart disease were not well understood.
Cross-Sectional (n=218)
No
Many young RHD patients choose bioprosthetic valves primarily to avoid warfarin, but significant gaps in post-operative dental and cardiology follow-up highlight the need for improved care pathways.
Bioprosthetic predominance signals follow-up gaps in RHD; leaves open drivers of valve selection and anticoagulation awareness.
Objective To understand the factors that influence rheumatic heart disease (RHD) patients' prosthetic heart valve choice, their knowledge of anticoagulation and subsequent experience. This is the first RHD-specific data on valve choice, including high-deprivation populations. Methods We performed a semi-quantitative, retrospective, cross-sectional survey study using a semi-structured telephone interview of patients (18–60 years) with RHD who had undergone valve replacement surgery from 2015 to 2020 at a single centre. Patients shared their experiences with prosthetic heart valves and warfarin. Results 138 patients completed or partially completed the survey from a total sample of 218 patients; mean age was 49 ± 10. 133 (61%) of patients had bioprosthetic valves implanted, and 85 (39%) had mechanical valves implanted. Younger and older patients were more likely to have bioprosthetic valves implanted, whereas middle-aged patients were more likely to have mechanical valves implanted. 38 (44%) of bioprosthetic valve patients specified warfarin avoidance, and 31 (62%) of mechanical valve patients specified avoidance of reoperation as their primary reason for choosing their respective valves (from 136 patients). 37 (43%) of bioprosthetic valve patients were informed that the durability of their valves would be at least 10-15 years (from 136 patients). The most helpful information providers regarding valve type were the surgeon and the cardiologist, whereas the GPs and cardiologists were for warfarin management. 64 (47%) had not seen a dentist, and 46 (34%) had not followed up with a cardiologist post-operatively (from 137 patients). Conclusion Many young RHD patients receive bioprosthetic valves; surgeons and cardiologists greatly influenced this choice. A uniform evidence-based education programme for health professionals may enhance decision-making around valve choice. Key findings A large proportion of young RHD patients receive bioprosthetic valves, and surgeons and cardiologists greatly influenced this choice. Many patients also do not see a dentist or cardiologist following surgery. A uniform evidence-based education programme for health professionals may enhance decision-making around valve choice, and free dental care and robust follow-up pathways would ensure this vulnerable group of patients is not lost to follow-up.
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Saha et al. (2026) conducted a cross-sectional in Rheumatic heart disease (n=218). Prosthetic heart valve replacement was evaluated on Prosthetic heart valve choice and primary reason for choice. Among patients with rheumatic heart disease undergoing valve replacement, 61% received bioprosthetic valves and 39% received mechanical valves, with surgeons and cardiologists greatly influencing this choice.
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