Background
Rheumatic heart disease (RHD) continues disproportionately among young Māori and Pacific Peoples in Aotearoa New Zealand (NZ)1. Concomitant aortic and mitral valve (AMV) disease is more common from the second decade2, and little is known about long-term outcomes after surgery in young people.
Methods
Single centre retrospective cohort study aged <18 years who had concomitant AMV surgery for RHD in NZ between 2005 – 2019. Baseline, early (6-24 months post-operative) and late (> 2 years postoperative or immediately prior to reoperation) data collected. Left ventricular (LV) dysfunction defined as ejection fraction (LVEF) <55% or shortening fraction (LVFS) <27%.
Results
98 patients median age 11.5 years (4-17 years), median weight 54kg (15-118kg). Two predominant operations – mitral and aortic valve repairs (47%) and mitral valve repair with aortic valve homograft replacement (41%). Pre-operative LV dysfunction present in 28% patients. 30-day mortality zero. Overall mortality 7/98 with median time from surgery to death of 10 years. Reoperation rate 46/98 (47%) after median 5 years (1 month-16 years). 8% underwent a second reoperation. Late follow up data: 25/78 (32%) had LV dysfunction – 8 of the 25 had pre-operative LV dysfunction which persisted, and 17/25 had new dysfunction. Late complications (infective endocarditis, thromboembolic event, arrhythmia, LV dysfunction, death) occurred in 63/98 (64%) patients.
Conclusions
This is the largest study assessing outcomes after surgery for mixed rheumatic AMV disease in young people globally. This cohort of young people are faced with high rates of re-operation and almost two thirds with late complications.