Key result
Mitral valve repair for rheumatic heart disease in young adults was associated with a medium-term mortality of 6.9% compared to 15.8% for mitral valve replacement (p=0.25).
Why the study?
Factors associated with the choice of surgical treatment for advanced rheumatic heart disease in young adults are poorly understood.
Does mitral valve repair compared to replacement improve survival and reduce complications in young adults with rheumatic heart disease?
Cohort (n=73)
No
Does mitral valve repair compared to replacement improve survival and reduce complications in young adults with rheumatic heart disease?
Absolute Event Rate: 6.9% vs 15.8%
p-value: p=0.25
In young adults with severe rheumatic heart disease, mitral valve repair shows a trend toward improved survival compared to replacement, while mechanical replacement is associated with increased bleeding complications and poor warfarin compliance.
BACKGROUND: Rheumatic heart disease (RHD) remains an important cause of morbidity and mortality in New Zealand. Factors associated with the choice of surgical treatment for advanced RHD in young adults are poorly understood. We sought to review our local experience with the surgical management of young adults with rheumatic mitral valvular disease. METHODS: From 2003 to 2016, all patients aged 15-24 years undergoing mitral valve surgery for rheumatic disease at Auckland City Hospital, New Zealand were retrospectively reviewed. RESULTS: During the 13-year study period, 73 young adults underwent mitral surgery; 85% were Maori or Pacific Islanders. Mitral repair was performed in 32 patients and replacement in 41 patients. Isolated mitral valve surgery was performed in 36%, double valve procedures in 47%, and triple valve procedures in 17% of patients. The 30-day mortality rate and stroke rate were 1.4% and 2.7% respectively. The medium-term mortality rate was 11.9% across a mean follow-up of 6 years (6.9% in the repair group, 15.8% in the replacement group, p = 0.25). There were increased bleeding complications (p = 0.04) in patients with mechanical mitral valve replacement. For patients on warfarin, across medium-term follow-up, the INR was in the therapeutic range only 23% of the time. CONCLUSION: Most young adults in New Zealand with severe RHD requiring surgery are of indigenous Maori or Pacific Island ethnicity. There is a trend towards improved survival with mitral repair. There is a significant tendency towards increased bleeding complications in patients on warfarin for mechanical mitral replacement. Warfarin compliance is poor.
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Singh et al. (2022) conducted a cohort in Rheumatic heart disease (n=73). Mitral valve repair vs. Mitral valve replacement was evaluated on Medium-term mortality (p=0.25). Mitral valve repair for rheumatic heart disease in young adults was associated with a medium-term mortality of 6.9% compared to 15.8% for mitral valve replacement (p=0.25).
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