Intermediate-term Outcomes Following Heart Valve Surgery in Rheumatic Heart Disease: A Retrospective Single-center Analysis from Eastern Nepal

Background: Rheumatic heart disease (RHD) is the leading cause of valvular heart disease requiring surgical intervention in low-income countries. Data on intermediate- and long-term surgical outcomes from Nepal are limited. This study aimed to evaluate intermediate-term outcomes following surgical intervention for RHD. Methods: This retrospective cohort study included all consecutive patients who underwent surgery for RHD between January 2016 and December 2021 at a tertiary care center in eastern Nepal. The primary endpoints were operative mortality, overall mortality, and 5- and 8-year survival. Secondary end points included major bleeding, valve thrombosis, stroke, and reoperation. Results: A total of 206 patients were included, with a mean follow-up duration of 62.58 ± 25.91 months. Single valve intervention (repair or replacement) was performed in 81.17% of patients, while the remainder underwent double valve replacement (DVR). Operative mortality was 3.39%, and overall late mortality during follow-up was 12.13%. The overall actuarial survival at 5 and 8 years was 90.7% ±3.1% and 79.2% ±7.4%, respectively. The corresponding survival rates for mitral valve replacement, aortic valve replacement, and DVR were 93.1 and 77.1%, 83.7% and 83.7%, and 89.9 and 84.9%, respectively. Late mortality was due to major intracranial bleeding in eight patients (3.88%), while the cause of death was unknown in nine patients (4.36%). The incidence of major bleeding requiring hospitalization was 1.97 events per 100 patient-years, including intracranial (4.85%), retroperitoneal (1.94%), intraperitoneal (0.97%), lower gastrointestinal (0.97%), and peripheral hematoma (0.97%) bleeding. Valve thrombosis occurred in four patients (0.38 events per 100 patient-years) and was successfully managed with thrombolysis. No reoperations were required. Conclusions: Valve replacement constitutes the majority of surgical interventions for RHD in our setting. Intermediate- to long-term outcomes are favorable and comparable to those reported in similar resource-limited settings.