Study comparison of RHD surgical outcomes across the Top End of the NT between 1964–1996 and 1997–2016
| Carapetis et al4 1964–1996 | Present study 1997–2016 | |
| Number of patients | 81 consecutive patients | 173 consecutive patients |
| Prior surgeries (PCMC or MVRep.) | 10/81 (12%) | 0 |
| Procedures other than pure MVR or AVR at the time of the replacement | 7 (7%) | 12 |
| Excluded from further analysis (perioperative/intraoperative mortality) | 1 | 0 |
| Median (IQR, range) age at first surgery (years) | 30 (24–38, 12–68) | 37 (27–46, 14–73) |
| Children* | 3 | 5 |
| Female† | 44/80 (55%) | 95 (55%) |
| Aboriginal | 70/80 (87%) | 173 (100%) |
| Remote residence | 54/80 (67%) | |
| Entry point | First RHD valve replacement | First RHD surgery |
| Median follow-up time (years) | 5 | 7 |
| Total patient-years | 561 | 1318 |
| Mitral valve replacement Aortic valve replacement Double valve replacement | 49 11 21 | 86 46 38 |
| Documented valve procedure | 64 mMVR, 4 bMVR, 27 mAVR, 2 bAVR | 41 mMVR, 45 bMVR, 15 mAVR, 31 bAVR, 23 mMVR+mAVR, 5 bMVR+bAVR, 3 MVRep+bAVR, 1 bMVR+AVRep, 3 bMVR+TVRep, 3 mMVR+TVRep, 1 MVRep+bAVR+TVRep 1 bMVR+bAVR+TVRep 1 bMVR+bAVR+bTVR |
| Preoperative Cardiac function Pulmonary artery systolic pressure (mm Hg)‡ Severely elevated if ≥50 mm Hg Left ventricular function. Impaired | 57 34 (55%) 23/60 (38%)§ | 53 (95% CI: 39 to 63) 66 (58%) 36/167 (22%)¶ |
| Total number of deaths | 29/80 (37%) | 62/173 (36%) |
| Survival (10-year survival) | 68% (54–79)** | 62% (52–70) |
| Overall linearised incidence rates (per 100 person-years) 95% CI death due to all causes | 5.3 | 4.6 (3.6–5.9) |
| Rate ratio (death due to all causes) | 0.9 (95% CI: 0.6 to 1.5) p=0.6 | |
*Children were defined as those <16 years at the time of first surgery.
†Binary (defined by health workers).
‡Pulmonary artery systolic pressure (mean mm Hg CI) measured at cardiac catheterisation or estimated by echocardiography in 62 vs 113 patients.
§Fractional shortening was less than 30% at echocardiography or reported as impaired at cardiac catheterisation.
¶LVEF≤51% in males and ≤53% in females or reported as normal during cardiac catheterisation.
**Does not include two non-RHD deaths.
AVRep, aortic valve repair; bAVR, bioprosthetic aortic valve replacement; bMVR, bioprosthetic mitral valve replacement; mAVR, mechanical aortic valve replacement ; ; mMVR, mechanical mitral valve replacement; MVRep, mitral valve repair; PCMC, percutaneous balloon mitral commissurotomy; RHD, rheumatic heart disease; TN, Northern Territory; TVRep, tricuspid valve repair; .