In this article, the authors report a nationwide study evaluating surgical mitral valve replacement (MVR) for rheumatic heart disease (RHD) in all 16 Dutch cardiothoracic centers between 2017 and 2023. Although RHD has declined in high–income countries, the authors write that migration continues to sustain its clinical relevance in the Netherlands. Among 2,488 MVR patients aged 75 years or younger, 435 had RHD. Patients were relatively young, predominantly female, and frequently had atrial fibrillation or advanced symptoms. Half underwent isolated MVR, while 48.5 percent required multivalve surgery. Mechanical mitral prostheses were used in 66.0 percent. The median follow–up was 2.9 years. In–hospital and 30–day mortality were both 4.1 percent, one-year mortality was 6.4 percent, and overall mortality was 12.2 percent. One–year mortality did not differ by center volume or compared with non–RHD MVR after adjustment.
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Surgical Care for Rheumatic Heart Disease Patients: Insights From the Netherlands Heart Registration
Submitted by: Vincent Sier
Source: European Heart Journal Valvular and Structural Heart Disease
Author(s): Lotte L. G. de Wilde, Sulayman el Mathari, Diederik W. M. Blokhuis, Maaike M. Roefs, Robert A. F. de Lind van Wijngaarden, Steven A. J. Chamuleau
2 Comments
This is a very interesting paper on poorly developed population coming from a well developed center. Overall mortality 12.2% among migrant population was it due to advanced disease processes (e.g. CHF) or due to active RHD that was operated emergently?
Thank you for this important question. Most patients were not operated under emergency conditions. In our cohort, 83.4% underwent elective surgery, 15.9% urgent surgery, whereas only 0.5% were operated as emergency cases and 0.2% as salvage procedures, suggesting that the observed overall mortality was unlikely to be explained by a large proportion of emergency operations.
As this study was based on the Netherlands Heart Registration, we were limited to the variables available within the registry and could not determine the exact cause of death or whether mortality was directly related to advanced heart failure or active rheumatic disease. However, although lower LVEF was independently associated with one-year mortality, pre-operative NYHA functional class was not independently associated with mortality in the multivariable Cox regression analysis (Supplementary Table 2). Therefore, our data do not suggest that differences in pre-operative symptomatic heart failure severity, as reflected by NYHA class, were the main explanation for the observed mortality.