Interventional Management of Indigenous Rheumatic Valvular Heart Disease at TPCH

Background: The incidence of rheumatic heart disease (RHD) in the indigenous Australian population is the highest in the world. Review of Queensland Patient Admitted Data Collection and TPCH cardiac clinical databases between January 2005 to December 2017 identified 240 indigenous patients undergoing any valve related interventional procedures at Metro North HHS. Of these 75 were performed for rheumatic valves at TPCH. Methods: Chart review and electronic database procedural data was analysed, with clinical follow up records, including echocardiography, being collated to identify survival and cardiac status following these interventions. Results: Rheumatic interventions were required over an age range of 10–69 years dominantly female 75%. Percutaneous mitral balloon valvuloplasty was performed in 15 patients, transcatheter aortic valve implantation in 1 patient. Surgical valve repair of 11 isolated mitral valves was achieved. Single valve replacement was possible in 10 with multiple valve repair/replacements required in the remaining 38 patients. Mechanical and tissue valves were utilized by 12 surgeons almost equally during replacement. Valve failure due to mitral valve thrombus formation, aortic prosthetic patient mismatch, and endocarditis required 7 reoperations. Hospital 30-day survival was 100%, 5year survival was 90% and 12year survival was 85%, estimated from medical record review. One reoperation following mitral valve repair has been required to date. Valve function on late follow up with clinical and echo data remains satisfactory. Conclusions: Mitral valve function is durable following balloon valvuloplasty or surgical repair in RHD. Risk to survival during all forms of intervention is low. The type of systemic heart valve utilized for replacement requires close consideration of patient geography, medical access and patient compliance.