1
|
Hamsanathan P, Katzenellenbogen JM, Andrews D, Carapetis J, Richmond P, McKinnon E, Ramsay J. A Review of Cardiac Surgical Procedures and Their Outcomes for Paediatric Rheumatic Heart Disease in Western Australia. Heart Lung Circ 2023; 32:1398-1406. [PMID: 37852820 DOI: 10.1016/j.hlc.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Surgical intervention is an important treatment modality for advanced rheumatic heart disease (RHD). This study aimed to describe patient characteristics and outcomes from cardiac surgery for RHD in patients referred to the only tertiary paediatric hospital in Western Australia. METHODS An analysis of patient characteristics and cardiac surgery outcomes in patients with RHD was undertaken, using data from clinical cardiac databases, medical notes, and correspondence from rural outreach clinics. RESULTS 29 patients (59% female, 97% Aboriginal, Māori or Pacific Islander) underwent 41 valve interventions over 34 cardiac surgeries for RHD between 2000-2018. Median age at first surgery was 12.2 (range 4-16) years. Severe mitral regurgitation (MR) was the most common indication for primary surgery (62%), followed by mixed mitral regurgitation/aortic regurgitation (21%) and severe aortic regurgitation (17%). Mitral valve repair was the most common valve intervention (56%). Two patients had mitral valve replacement (MVR) at first operation, two patients had MVR at second operation and two had MVR at third operation. There was no early mortality. One patient required early (<30 days) reoperation for aortic valve repair failure. Two patients had late reoperations at 3.3 and 6.1 months after the first procedure for MR. Four (14%) patients experienced documented ARF recurrences. Late mortality occurred in 3 (10%) patients, all due to cardiac causes. On last follow-up echocardiogram 5 patients (17%) had moderate MR and none had severe MR. CONCLUSIONS This is the first study to describe characteristics and outcomes in WA paediatric patients having surgery for RHD. Outcomes are comparable to similar studies, with favourable long-term survival.
Collapse
Affiliation(s)
| | - Judith M Katzenellenbogen
- The School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - David Andrews
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia
| | - Jonathan Carapetis
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia; Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Peter Richmond
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia; The School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - Elizabeth McKinnon
- Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - James Ramsay
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia
| |
Collapse
|
2
|
MacDonald B, Tarca A, Causer L, Maslin K, Bruce D, Schreiber-Wood R, Kumar M, Ramsay J, Andrews D, Budgeon C, Katzenellenbogen J, Bowen AC, Carapetis J, Friedberg MK, Yim D. Left ventricular remodelling in rheumatic heart disease - trends over time and implications for follow-up in childhood. BMC Cardiovasc Disord 2023; 23:462. [PMID: 37715115 PMCID: PMC10503178 DOI: 10.1186/s12872-023-03497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is the most common form of acquired heart disease worldwide. In RHD, volume loading from mitral regurgitation leads to left ventricular (LV) dilatation, increased wall stress, and ultimately LV dysfunction. Improved understanding of LV dynamics may contribute to refined timing of intervention. We aimed to characterize and compare left ventricular remodelling between rheumatic heart disease (RHD) severity groups by way of serial echocardiographic assessment of volumes and function in children. METHODS Children with RHD referred to Perth Children's Hospital (formally Princess Margaret Hospital) (1987-2020) were reviewed. Patients with longitudinal pre-operative echocardiograms at diagnosis, approximately 12 months and at most recent follow-up, were included and stratified into RHD severity groups. Left ventricular (LV) echocardiographic parameters were assessed. Adjusted linear mixed effect models were used to compare interval changes. RESULTS 146 patients (median age 10 years, IQR 6-14 years) with available longitudinal echocardiograms were analysed. Eighty-five (58.2%) patients had mild, 33 (22.6%) moderate and 28 (19.2%) severe RHD at diagnosis. Mean duration of follow-up was 4.6 years from the initial diagnosis. Severe RHD patients had significantly increased end-systolic volumes (ESV) and end-diastolic volumes (EDV) compared to mild/moderate groups at diagnosis (severe versus mild EDV mean difference 27.05 ml/m2, p < 0.001, severe versus moderate EDV mean difference 14.95 ml/m2, p = 0.006). Mild and moderate groups experienced no significant progression of changes in volume measures. In severe RHD, LV dilatation worsened over time. All groups had preserved cardiac function. CONCLUSIONS In mild and moderate RHD, the lack of progression of valvular regurgitation and ventricular dimensions suggest a stable longer-term course. Significant LV remodelling occurred at baseline in severe RHD with progression of LV dilatation over time. LV function was preserved across all groups. Our findings may guide clinicians in deciding the frequency and timing of follow-up and may be of clinical utility during further reiterations of the Australia and New Zealand RHD Guidelines.
Collapse
Affiliation(s)
- Bradley MacDonald
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia.
- School of Population and Global Health, University of Western Australia, Perth, Australia.
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia.
| | - Adrian Tarca
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Louise Causer
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Katie Maslin
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Di Bruce
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Rachel Schreiber-Wood
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Mohit Kumar
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - James Ramsay
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - David Andrews
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Charley Budgeon
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Judith Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Perth, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Asha C Bowen
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Jonathan Carapetis
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Deane Yim
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| |
Collapse
|
3
|
Knox A, Bennetts JS, Gimpel D, Newland RF, Baker RA, Joseph MX, Rice GD, Kangaharan N, Sinhal A. Transcatheter mitral valve-in-valve: treatment of rheumatic heart disease in young patients. ANZ J Surg 2022; 92:3298-3303. [PMID: 36200709 DOI: 10.1111/ans.18076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/28/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve-in-valve (TMViV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. METHODS A single-centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post-operative trans-thoracic echocardiogram (TTE) results. RESULTS There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre-operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post-operative median length of hospital stay was 4 days with no post-operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post-operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow-up of 22 months. CONCLUSION Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.
Collapse
Affiliation(s)
- Abbey Knox
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Jayme S Bennetts
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Damian Gimpel
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Richard F Newland
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert A Baker
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Majo X Joseph
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Gregory D Rice
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nadarajah Kangaharan
- Cardiology and Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| |
Collapse
|
4
|
Rwebembera J, Nascimento BR, Minja NW, de Loizaga S, Aliku T, dos Santos LPA, Galdino BF, Corte LS, Silva VR, Chang AY, Dutra WO, Nunes MCP, Beaton AZ. Recent Advances in the Rheumatic Fever and Rheumatic Heart Disease Continuum. Pathogens 2022; 11:pathogens11020179. [PMID: 35215123 PMCID: PMC8878614 DOI: 10.3390/pathogens11020179] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Nearly a century after rheumatic fever (RF) and rheumatic heart disease (RHD) was eradicated from the developed world, the disease remains endemic in many low- and middle-income countries (LMICs), with grim health and socioeconomic impacts. The neglect of RHD which persisted for a semi-centennial was further driven by competing infectious diseases, particularly the human immunodeficiency virus (HIV) pandemic. However, over the last two-decades, slowly at first but with building momentum, there has been a resurgence of interest in RF/RHD. In this narrative review, we present the advances that have been made in the RF/RHD continuum over the past two decades since the re-awakening of interest, with a more concise focus on the last decade’s achievements. Such primary advances include understanding the genetic predisposition to RHD, group A Streptococcus (GAS) vaccine development, and improved diagnostic strategies for GAS pharyngitis. Echocardiographic screening for RHD has been a major advance which has unearthed the prevailing high burden of RHD and the recent demonstration of benefit of secondary antibiotic prophylaxis on halting progression of latent RHD is a major step forward. Multiple befitting advances in tertiary management of RHD have also been realized. Finally, we summarize the research gaps and provide illumination on profitable future directions towards global eradication of RHD.
Collapse
Affiliation(s)
- Joselyn Rwebembera
- Department of Adult Cardiology (JR), Uganda Heart Institute, Kampala 37392, Uganda
- Correspondence: or ; Tel.: +256-779010527
| | - Bruno Ramos Nascimento
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
- Servico de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaude, Hospital das Clinicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, 1st Floor, Belo Horizonte 30130-100, MG, Brazil
| | - Neema W. Minja
- Rheumatic Heart Disease Research Collaborative in Uganda, Uganda Heart Institute, Kampala 37392, Uganda;
| | - Sarah de Loizaga
- School of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA; (S.d.L.); (A.Z.B.)
| | - Twalib Aliku
- Department of Paediatric Cardiology (TA), Uganda Heart Institute, Kampala 37392, Uganda;
| | - Luiza Pereira Afonso dos Santos
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Bruno Fernandes Galdino
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Luiza Silame Corte
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Vicente Rezende Silva
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Andrew Young Chang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Walderez Ornelas Dutra
- Laboratory of Cell-Cell Interactions, Institute of Biological Sciences, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- National Institute of Science and Technology in Tropical Diseases (INCT-DT), Salvador 40170-970, BA, Brazil
| | - Maria Carmo Pereira Nunes
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
- Servico de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaude, Hospital das Clinicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, 1st Floor, Belo Horizonte 30130-100, MG, Brazil
| | - Andrea Zawacki Beaton
- School of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA; (S.d.L.); (A.Z.B.)
- Cincinnati Children’s Hospital Medical Center, The Heart Institute, Cincinnati, OH 45229, USA
| |
Collapse
|
5
|
Bamford P, Said C, Al-Omary MS, Bhagwandeen R, Boyle A. Aortic Valve Replacement Rates in Australia from 2004 to 2019. Intern Med J 2021; 53:525-530. [PMID: 34780091 DOI: 10.1111/imj.15624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several surgical and percutaneous treatments are available for patients with aortic valve disease. AIM Our aim is to establish whether trends in aortic valve replacements (AVR) in Australia reflect recent evidence. METHODS Using Australian Institute of Health and Welfare data, this study counted all AVR and balloon aortic valvuloplasty (BAV) procedures conducted in all Australian hospitals from 2004 to 2019. Linear regression analysis was performed to determine whether age-adjusted rates had changed over the study period. RESULTS There were 80,883 AVRs performed. 66% were men and 64% were over aged 70. Absolute rates of AVR increased from 3,631 to 7,277 with a significant 22% age-adjusted rise seen (1.9% increase per year (+0.26 per 100,000 per year, 95% CI 0.19 - 0.34); p < 0.001). This trend was more pronounced in men than women and in over 80 year-olds (+0.23 per 100,000 per year, p < 0.001). Proportion of mechanical AVRs implanted fell from 38.4% to 8.6% (p<0.001). 2,683 transcatheter aortic valve implantation (TAVI) procedures were performed in 2019, representing a 52% annual increase from 2014. BAV increased from 66 procedures in 2004 to 862 in 2019. CONCLUSION Rates of AVR have increased significantly over the past 16 years, particularly in the elderly. Despite international guideline recommendations, fewer mechanical AVRs are being used in younger cohorts. The uptake in TAVI rates might reflect evidence that suggests it is a safe alternative, at least in the medium term. BAV has also seen a resurgence during this time period. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Paul Bamford
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | | | - Mohammed S Al-Omary
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | - Rohan Bhagwandeen
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | - Andrew Boyle
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| |
Collapse
|
6
|
Lopes MP, Rosa VEE, Palma JH, Vieira MLC, Fernandes JRC, de Santis A, Spina GS, Fonseca RDJ, de Sá Marchi MF, Abizaid A, de Brito FS, Tarasoutchi F, Sampaio RO, Ribeiro HB. Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease. Front Cardiovasc Med 2021; 8:694339. [PMID: 34422923 PMCID: PMC8373457 DOI: 10.3389/fcvm.2021.694339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups (p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.
Collapse
Affiliation(s)
- Mariana Pezzute Lopes
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | - José Honório Palma
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | | | - Antonio de Santis
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | | | | | - Alexandre Abizaid
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | - Flavio Tarasoutchi
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | |
Collapse
|
7
|
Pediatric rheumatic carditis in Italy and Rwanda: The same disease, different socio-economic settings. Int J Cardiol 2021; 338:154-160. [PMID: 34146584 DOI: 10.1016/j.ijcard.2021.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/23/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute Rheumatic Fever and Rheumatic Heart Disease are the leading cause of acquired heart disease in Low-Income Countries, and a common cause in High-Income Countries. We compared rheumatic carditis, its echocardiographic presentation at diagnosis and its progression in Italy and Rwanda. METHODS Retrospective study including all consecutive patients diagnosed with rheumatic carditis in an Italian (IT) and two Rwandan Hospitals (RW). Echocardiography was performed at diagnosis and three follow-up visits. Baseline characteristics, history of primary and secondary prophylaxis and cardiovascular complications data were collected. RESULTS Seventy-nine and 135 patients were enrolled in IT and RW, respectively. Mitral regurgitation was the most common lesion (IT: 70%, RW: 96%) in both cohorts; mixed valve lesions and severe lesions were more prevalent in RW. Age at diagnosis (IT: 8.4 ± 2.9 yrs.; RW: 11.1 ± 2.7 yrs.; P < 0.001), adherence to secondary prophylaxis (IT: 99%; RW: 48%; P < 0.001) and history of primary prophylaxis (IT: 65%; RW: 6%; P < 0.001) were different. During the follow-up, native valve lesions completely resolved in 38% of IT and in 2% of RW patients (P < 0.001). By contrast, cardiac surgery was performed in 31% of RW and 5% of IT patients (P < 0.001). Cardiovascular complications and death were only observed in RW. CONCLUSIONS The more severe cardiac involvement, the higher rate of valve surgery, CV complications and deaths in RW, could be due to delayed diagnosis and treatment, scarce adherence to secondary prophylaxis and differences in social determinants of health.
Collapse
|
8
|
Bradshaw PJ, Tohira H, Marangou J, Newman M, Reményi B, Wade V, Reid C, Katzenellenbogen JM. The use of cardiac valve procedures for rheumatic heart disease in Australia; a cross-sectional study 2002-2017. Ann Med Surg (Lond) 2020; 60:557-565. [PMID: 33299561 PMCID: PMC7704359 DOI: 10.1016/j.amsu.2020.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022] Open
Abstract
Background Australia, although a high income economy, carries a significant burden of rheumatic heart disease (RHD). Acute rheumatic fever (ARF) and RHD are endemic in the Indigenous population. Immigrants from low/lower-income countries (‘non-Indigenous high-risk’) are also at increased risk compared with ‘non-Indigenous low-risk’ Australians. This study describes the utilisation of surgical and percutaneous procedures for RHD-related valve disease among patients aged less than 50 years, from 2002 to 2017. Methods A descriptive study using data from the ‘End RHD in Australia: Study of Epidemiology (ERASE) Project’ linking RHD Registers and hospital inpatient data from five states/territories, and two surgical databases. Trends across three-year periods were determined and post-procedural all-cause 30-day mortality calculated. Results A total of 3900 valves interventions were undertaken in 3028 procedural episodes among 2487 patients. Over 50% of patients were in the 35–49 years group, and 64% were female. Over 60% of procedures for 3-24 year-olds were for Indigenous patients. There were few significant changes across the study period other than downward trends in the number and proportion of procedures for young Indigenous patients (3–24 years) and ‘non-Indigenous/low risk’ patients aged ≥35 years. Mitral valve procedures predominated, and multi-valve interventions increased, including on the tricuspid valve. The majority of replacement prostheses were mechanical, although bioprosthetic valve use increased overall, being highest among females <35 years and Indigenous Australians. All-cause mortality (n = 42) at 30-days was 1.4% overall (range 1.1–1.7), but 2.0% for Indigenous patients. Conclusions The frequency of cardiac valve procedures, and 30-day mortality remained steady across 15 years. Some changes in the distribution of procedures in population groups were evident. Replacement procedures, the use of bioprosthetic valves, and multiple-valve interventions increased. The challenge for Australian public health officials is to reduce the incidence, and improve the early detection and management of ARF/RHD in high-risk populations within Australia. Epidemic RHD in Indigenous Australians drives RHD-related cardiac valve procedures. 30-day mortality post-procedural is low in those under 50 years. Bioprosthetic valve replacements higher in young women, and increasing in older patients.
Collapse
Affiliation(s)
- Pamela J Bradshaw
- The School of Population and Global Health, The University of Western Australia, Australia
| | - Hideo Tohira
- The School of Population and Global Health, The University of Western Australia, Australia
| | - James Marangou
- Fiona Stanley Hospital, 11 Robin Warren Drive Murdoch, WA, 6150, Australia
| | - Mark Newman
- Sir Charles Gairdner Hospital, Hospital Ave. Nedlands, WA, 6009, Australia
| | - Bo Reményi
- Menzies School of Health Research, PO Box, 41096, Casuarina, NT, Australia
| | - Vicki Wade
- Menzies School of Health Research, PO Box, 41096, Casuarina, NT, Australia
| | - Christopher Reid
- The Centre for Research Excellence Centre of Clinical Research and Education, Curtin University, Hayman Rd. Bentley, WA, Australia
| | | |
Collapse
|
9
|
McBride KF, Rolleston A, Grey C, Howard NJ, Paquet C, Brown A. Māori, Pacific, Aboriginal and Torres Strait Islander Women's Cardiovascular Health: Where Are the Opportunities to Make a Real Difference? Heart Lung Circ 2020; 30:52-58. [PMID: 33162366 DOI: 10.1016/j.hlc.2020.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
Māori and Pacific women in New Zealand and Aboriginal and Torres Strait Islander women in Australia are recognised as nurturers and leaders within their families and communities. However, women's wellbeing, and that of their communities, are affected by a high burden of cardiovascular disease experienced at a younger age than women from other ethnic groups. There has been little focus on the cardiovascular outcomes and strategies to address heart health inequities among Māori, Pacific, Aboriginal and Torres Strait Islander women. The factors contributing to these inequities are complex and interrelated but include differences in exposure to risk and protective factors, rates of multi-morbidity, and substantial gaps within the health system, which include barriers to culturally responsive, timely and appropriate cardiovascular care. Evidence demonstrates critical treatment gaps across the continuum of risk and disease, including assessment and management of cardiovascular risk in young women and time-critical access to and receipt of acute services. Cardiovascular disease in women impacts not only the individual, but their family and community, and the burden of living with disease limits women's capacity to fulfil their roles and responsibilities which support and sustain families and communities. Our response must draw on the strengths of Māori, Pacific, Aboriginal and Torres Strait Islander women, acknowledge health and wellbeing holistically, address the health and social needs of individuals, families and communities, and recognise that Indigenous women in New Zealand, Australia and across the Pacific must be involved in the design, development and implementation of solutions affecting their own health.
Collapse
Affiliation(s)
- Katharine F McBride
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Corina Grey
- Auckland District Health Board, Auckland, New Zealand
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Paquet
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
| |
Collapse
|
10
|
Saksena D, Mishra YK, Muralidharan S, Kanhere V, Srivastava P, Srivastava CP. Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario. Indian J Thorac Cardiovasc Surg 2019; 35:3-44. [PMID: 33061064 PMCID: PMC7525528 DOI: 10.1007/s12055-019-00789-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. METHODS A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. RESULTS The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. CONCLUSIONS Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.
Collapse
|
11
|
Chengode S, Shabadi RV, Rao RN, Alkemyani N, Alsabti H. Perioperative management of transcatheter, aortic and mitral, double valve-in-valve implantation during pregnancy through left ventricular apical approach. Ann Card Anaesth 2018; 21:185-188. [PMID: 29652282 PMCID: PMC5914221 DOI: 10.4103/aca.aca_157_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pregnant women with stenotic degeneration of bioprosthetic cardiac valves may require another valve replacement procedure when their symptoms deteriorate with progression of pregnancy, but fetal mortality is higher with cardiac surgery done on cardiopulmonary bypass. Transcatheter valve-in-valve implantation may help to improve the fetal and maternal outcomes in these situations. Double valve-in-valve implantation is rare and has not been reported in a pregnant patient. We report, for the first time, the case of a pregnant woman with stenotic bioprosthetic valves in the mitral and aortic positions, who underwent a successful concomitant, transcatheter, double valve-in-valve implantation through the left ventricular apical route during the second trimester of her precious pregnancy.
Collapse
Affiliation(s)
- Suresh Chengode
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rahul Vijaykumar Shabadi
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ram Narayan Rao
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasser Alkemyani
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hilal Alsabti
- Department of Surgery, Division of Cardiac Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
12
|
Farnsworth JH, Krieg BM, Bennetts JS, Baker RA. Public Health Costs for Northern Territory and South Australian Cardiac Surgery Patients. Heart Lung Circ 2018; 28:1720-1727. [PMID: 30309712 DOI: 10.1016/j.hlc.2018.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The cost of performing cardiac surgery in the public health system in Australia is unclear. This paper analyses the cost of cardiac surgery performed at Flinders Medical Centre (FMC), South Australia, comparing cost by procedure, rheumatic valvular heart disease status, Aboriginality and location. METHODS This study is a retrospective, population-based analysis of cardiac surgery data held in the Cardiac Surgery Registry cross-referenced to cost data provided by the FMC Department of Finance and Patient Travel, Accommodation and Transport Services at the Royal Darwin Hospital. Seven hundred ninety-five (795) patients who underwent cardiac surgery at FMC from 1 July 2014 to 30 June 2016 were included. RESULTS Across all procedures, Northern Territory (NT) Aboriginal patients had a mean total cost of $78,506 which was $24,113 more than NT non-Aboriginal, $28,443 more than South Australian (SA) Aboriginal and $22,955 more than SA non-Aboriginal patients. The total cost of a patient undergoing a repeat sternotomy (reoperative procedure) was found to be significantly higher than a primary procedure ($85,797 versus $59,097). In patients undergoing valve surgery procedures, those identified with rheumatic heart disease had a higher mean total cost than those without (a difference of $25,094). Significantly, the rheumatic patient group showed a higher proportion of reoperative procedures (19% versus 5%). CONCLUSIONS The cost of treating NT Aboriginal cardiac surgical patients remotely has a significant financial impact upon the health care delivery system, as does the impact of rheumatic heart disease. This study found that the cost for the NT Aboriginal patient group was substantially higher than the NT non-Aboriginal, SA Aboriginal and SA non-Aboriginal patient groups. The additional cost to family and dislocation of social structures is not able to be calculated, but would also clearly weigh heavily on both patient groups. These findings suggest that future health funding models should recognise Aboriginality, remoteness and rheumatic heart disease.
Collapse
Affiliation(s)
| | | | - Jayme S Bennetts
- Flinders University School of Medicine, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | - Robert A Baker
- Flinders University School of Medicine, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia.
| |
Collapse
|
13
|
Keenan NM, Newland RF, Baker RA, Rice GD, Bennetts JS. Outcomes of Redo Valve Surgery in Indigenous Australians. Heart Lung Circ 2018; 28:1102-1111. [PMID: 30139596 DOI: 10.1016/j.hlc.2018.05.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/13/2018] [Accepted: 05/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rheumatic heart disease often leads to valve surgery at a young age in our Indigenous population. Anticoagulation can be problematic and therefore repeat surgery to replace degenerated bioprosthetic valves is common. We sought to examine outcomes following redo valve surgery in this population. METHODS Data from our institutional database was reviewed from 1992 to 2017. During this period, 82 redo valve surgeries were performed in 73 patients identifying as Aboriginal and Torres Strait Islander. We compared this study group to Indigenous patients undergoing primary valve surgery (n=389) and non-Indigenous patients undergoing redo valve surgery (n=154). RESULTS Redo patients had a median age of 29.5 years (IQR 24, 44), 59% were female, and they had significant comorbidities. The 30-day mortality in this cohort was 6% (EuroSCORE II 3.57), and they had significant morbidity. The median time to repeat surgery in those who had previous mitral valve surgery was 6.3 years, with no difference between mitral valve repair or replacement at the index procedure. Compared to non-Indigenous patients undergoing redo valve surgery, the Indigenous patients were significantly younger with higher left ventricular function but a greater proportion of pulmonary hypertension. There were no significant differences in short-term outcomes. Compared to Indigenous patients undergoing primary valve surgery, the Indigenous redo patients were significantly younger with more co-morbidities. There was no difference in 30-day mortality, but the redo patients did have significantly greater resource utilisation (increased hospital and intensive care unit (ICU) lengths of stay, ventilation and blood transfusion) and poorer long-term survival. CONCLUSIONS Indigenous patients presenting for redo valve surgery represent a complex and comorbid group of patients, with outcomes worse than expected in a young population, albeit comparable within study groups. Time from original surgery was short at 6 years, and thus a strategy must be in place in terms of planning future surgeries in this cohort of predominantly young rheumatic heart disease patients.
Collapse
Affiliation(s)
| | - Richard F Newland
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | - Robert A Baker
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | | | - Jayme S Bennetts
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia.
| |
Collapse
|
14
|
|
15
|
de Aquino Xavier RM, Azevedo VMP, Godoy PH, Migowski A, Ribeiro ALP, Chaves RBM, Correia MG, de Aquino Xavier C, de Aquino Hashimoto L, Weksler C, Silva NASE. Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study. BMC Cardiovasc Disord 2017; 17:302. [PMID: 29284400 PMCID: PMC5745641 DOI: 10.1186/s12872-017-0725-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Heart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival. METHODS This was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002-7.707). RESULTS Valve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001). CONCLUSIONS Rheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.
Collapse
Affiliation(s)
- Regina Maria de Aquino Xavier
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | - Vitor Manuel Pereira Azevedo
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | | | - Arn Migowski
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Antonio Luiz Pinho Ribeiro
- University Hospital and School of Medicine - Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil
| | - Rogério Brant Martins Chaves
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Marcelo Goulart Correia
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Carolina de Aquino Xavier
- University Hospital and School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Clara Weksler
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
16
|
Russell EA, Walsh WF, Reid CM, Tran L, Brown A, Bennetts JS, Baker RA, Tam R, Maguire GP. Outcomes after mitral valve surgery for rheumatic heart disease. HEART ASIA 2017; 9:e010916. [PMID: 29467839 DOI: 10.1136/heartasia-2017-010916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 11/03/2022]
Abstract
Objective To further the understanding of the factors influencing outcome following rheumatic heart disease (RHD) related mitral valve surgery, which globally remains an important cause of heart disease and a particular problem in Indigenous Australians. Methods The Australian Cardiac Surgery Database was utilised to assess outcomes following mitral valve repair and replacement for RHD and non-RHD valve disease. The association with aetiology, demographics, comorbidities, preoperative status and operative procedure was evaluated. Results Mitral valve repairs and replacements undertaken in Australia were analysed from 119 and 1078 RHD surgical procedures and 3279 and 2400 non-RHD procedures, respectively. RHD mitral valve repair, compared with replacement, resulted in a slightly shorter hospital stay and more reoperation for valve dysfunction, but no difference in 30-day survival. In unadjusted survival analysis to 5 years, RHD mitral valve repair and replacement were no different (HR 0.86, 95% CI 0.4 to 1.7), non-RHD repair was superior to replacement (HR 1.7, 95% CI 1.4 to 2.0), RHD and non-RHD repair were no different (HR 0.9, 95% CI 0.5 to 1.7), and RHD replacement was superior to non-RHD (HR 1.5, 95% CI 1.2 to 1.9). None of these differences persisted in adjusted analyses and there was no difference in long-term survival for Indigenous Australians. Conclusion In this large prospective cohort study we have demonstrated that adjusted long-term survival following RHD mitral valve repair surgery in Australia is no different to replacement and no different to non-RHD. Interpretation of valve surgery outcome requires careful consideration of patient factors that may also influence survival.
Collapse
Affiliation(s)
- E Anne Russell
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Warren F Walsh
- Department of Cardiology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Christopher M Reid
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - Lavinia Tran
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, Australia.,School of Population Health, University of South Australia, Adelaide, South Australia
| | - Jayme S Bennetts
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Surgery, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Robert A Baker
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Robert Tam
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Graeme P Maguire
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Russell EA, Reid CM, Walsh WF, Brown A, Maguire GP. Outcome following valve surgery in Australia: development of an enhanced database module. BMC Health Serv Res 2017; 17:43. [PMID: 28095841 PMCID: PMC5240444 DOI: 10.1186/s12913-017-2002-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Valvular heart disease, including rheumatic heart disease (RHD), is an important cause of heart disease globally. Management of advanced disease can include surgery and other interventions to repair or replace affected valves. This article summarises the methodology of a study that will incorporate enhanced data collection systems to provide additional insights into treatment choice and outcome for advanced valvular disease including that due to RHD. METHODS An enhanced data collection system will be developed linking an existing Australian cardiac surgery registry to more detailed baseline co-morbidity, medication, echocardiographic and hospital separation data to identify predictors of morbidity and mortality outcome following valve surgery. DISCUSSION This project aims to collect and incorporate more detailed information regarding pre and postoperative factors and subsequent morbidity. We will use this to provide additional insights into treatment choice and outcome.
Collapse
Affiliation(s)
- E. Anne Russell
- Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004 Australia
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Christopher M Reid
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
- School of Public Health, Curtin University, Perth, WA Australia
| | | | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, SA Australia
- School of Population Health, University of South Australia, Adelaide, SA Australia
| | - Graeme P Maguire
- Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004 Australia
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
| |
Collapse
|
18
|
Yangni-Angate KH, Meneas C, Diby F, Diomande M, Adoubi A, Tanauh Y. Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire. Cardiovasc Diagn Ther 2016; 6:S44-S63. [PMID: 27904843 DOI: 10.21037/cdt.2016.10.06] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. METHODS It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. RESULTS There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). CONCLUSIONS OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.
Collapse
Affiliation(s)
- Koffi Herve Yangni-Angate
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Christophe Meneas
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Florent Diby
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Manga Diomande
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire
| | - Anicet Adoubi
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Yves Tanauh
- Department of Thoracic Surgery, Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| |
Collapse
|
19
|
Saidi T, Douglas TS. Minimally invasive transcatheter aortic valve implantation for the treatment of rheumatic heart disease in developing countries. Expert Rev Med Devices 2016; 13:979-985. [DOI: 10.1080/17434440.2016.1236679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Trust Saidi
- Faculty of Health Sciences, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Tania S. Douglas
- Faculty of Health Sciences, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
20
|
Russell EA, Tran L, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Walsh WF, Maguire GP. A review of outcome following valve surgery for rheumatic heart disease in Australia. BMC Cardiovasc Disord 2015; 15:103. [PMID: 26399240 PMCID: PMC4580994 DOI: 10.1186/s12872-015-0094-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022] Open
Abstract
Background Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing outcome following surgery for RHD. Methods The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to assess outcomes following surgical procedures for RHD and non-RHD valvular disease. The association with demographics, co-morbidities, pre-operative status, valve(s) affected and operative procedure was evaluated. Results Outcome of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients had longer ventilation, experienced fewer strokes and had more readmissions to hospital and anticoagulant complications. Mortality following RHD surgery at 30 days was 3.1 % (95 % CI 2.2 – 4.3), 5 years 15.3 % (11.7 – 19.5) and 10 years 25.0 % (10.7 – 44.9). Mortality following non-RHD surgery at 30 days was 4.3 % (95 % CI 3.9 - 4.6), 5 years 17.6 % (16.4 - 18.9) and 10 years 39.4 % (33.0 - 46.1). Factors independently associated with poorer longer term survival following RHD surgery included older age (OR1.03/additional year, 95 % CI 1.01 – 1.05), concomitant diabetes (OR 1.7, 95 % CI 1.1 – 2.5) and chronic kidney disease (1.9, 1.2 – 2.9), longer invasive ventilation time (OR 1.7 if greater than median value, 1.1– 2.9) and prolonged stay in hospital (1.02/additional day, 1.01 – 1.03). Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians. Conclusion In a large prospective cohort study we have demonstrated survival following RHD valve surgery in Australia is comparable to earlier studies. Patients with diabetes and chronic kidney disease, were at particular risk of poorer long-term survival. Unlike earlier studies we did not find pre-existing atrial fibrillation, being an Indigenous Australian or the nature of the underlying valve lesion were independent predictors of survival.
Collapse
Affiliation(s)
- E Anne Russell
- Baker IDI, Melbourne, VIC, 3004, Australia. .,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lavinia Tran
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Robert A Baker
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, South Australia.
| | - Jayme S Bennetts
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, South Australia. .,Department of Surgery, School of Medicine, Flinders University, Adelaide, South Australia.
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, South Australia. .,School of Population Health, University of South Australia, Adelaide, South Australia.
| | - Christopher M Reid
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,School of Public Health, Curtin University, Perth, Western Australia.
| | - Robert Tam
- Director of Surgery, Department of Cardiothoracic Surgery, Townsville Hospital, Queensland, Australia.
| | | | - Graeme P Maguire
- Baker IDI, Melbourne, VIC, 3004, Australia. .,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,School of Medicine, James Cook University, Cairns, QLD, Australia.
| |
Collapse
|
21
|
Katzenellenbogen JM, Woods JA, Teng THK, Thompson SC. Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review. BMC Cardiovasc Disord 2015; 15:87. [PMID: 26268309 PMCID: PMC4535416 DOI: 10.1186/s12872-015-0081-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022] Open
Abstract
Background The epidemiology of atrial fibrillation (AF) among Indigenous minorities in affluent countries is poorly delineated, despite the high cardiovascular disease burden in these populations. We undertook a systematic scoping review examining the epidemiology of AF in the Indigenous populations of Australia, Canada, New Zealand (NZ) and the United States (US). Methods PubMed, Scopus, EMBASE and CINAHL-Plus databases were systematically searched in May 2014. Supplementary full-text searches of Google Scholar and government website searches were also undertaken. Results Key findings from 27 publications with diverse aims and methods were included. Small studies from Canada and NZ suggest higher AF prevalence in Indigenous than other populations. However, this was not reflected in a large sample of US male military veterans. No data were identified on community-based incidence rates of AF in Indigenous populations. Australian and Canadian studies indicate higher first-ever and overall AF hospitalisation rates among Indigenous than other populations, at younger ages and with more comorbidity. Studies in stroke, heart failure and other clinical groups demonstrate AF as a common comorbidity, with AF possibly more prevalent at younger ages in Indigenous people. Indigenous patients have similar early post-hospitalisation adjusted mortality but higher 1-year risk-adjusted mortality than non-Indigenous patients. Conclusions No clear epidemiological pattern of AF frequency across the considered Indigenous populations emerges from the limited available evidence. AF should be included in key conditions reported in national surveillance reports, although Indigenous identifiers are required in administrative data from Canada and the US. Sufficiently powered, community-based studies of AF epidemiology in diverse Indigenous populations are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0081-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Judith M Katzenellenbogen
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,School of Population Health, The University of Western Australia (M431), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - John A Woods
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| |
Collapse
|