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Isolated mechanical aortic valve replacement in rheumatic patients in a low- to middle-income country
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 157:886-893
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Objective Although the results of aortic valve replacement are well documented for industrialized countries, the outcome in patients with rheumatic aortic valve disease in low- to middle-income countries is less well explored. The aim of this study was to determine the long-term survival and clinical outcomes after isolated aortic valve replacement in patients with rheumatic heart disease in a Sub-Saharan country where follow-up of indigent patients is often challenging. Methods A retrospective review of 969 aortic valve replacements performed between 2003 and 2013 was conducted at Cape Town's Groote Schuur Hospital. Patients who underwent concomitant procedures (n = 664) or had nonrheumatic valve pathology (n = 185) were excluded. The mean age of the rheumatic cohort (n = 121) was 43.1 ± 11.6 years with a mean follow-up period of 6.14 ± 3.44 years. The primary end points were survival and valve-related complications. Results A 15% cardiac- or valve-related 10-year mortality after receiving a mechanical prosthesis corresponded with a significantly higher mortality rate than that of a matched population. Overall cumulative survival at 1, 5, and 10 years was 93.5% (87.0-96.9), 86.4% (78.4-91.8), and 78.1% (67.5-86.0), respectively, and the corresponding cumulative freedom from combined thromboembolism and bleeding was 94.4% (88.2-97.5), 87.4% (79.4-92.5), and 86.1% (77.9-91.6), respectively. Conclusions In low- to middle-income countries, with their unique mix of indigent and “First World” patients, rheumatic heart disease still accounts for a significant proportion of patients requiring isolated aortic valve replacement. Although mechanical prostheses are often selected in these young adults, survival remains suboptimal. Major bleeding and thromboembolic events account for the majority (77%) of the reported valve-related complications.
- Subjects :
- Pulmonary and Respiratory Medicine
Aortic valve
medicine.medical_specialty
education.field_of_study
Heart disease
business.industry
Mortality rate
Population
Mechanical Aortic Valve
030204 cardiovascular system & hematology
medicine.disease
Surgery
03 medical and health sciences
0302 clinical medicine
medicine.anatomical_structure
030228 respiratory system
Aortic valve replacement
Concomitant
Cohort
medicine
Cardiology and Cardiovascular Medicine
business
education
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 157
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....b05f5895deead0efb2513b7d5474a03f