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Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?

BACKGROUND: Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improveme...

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Autores principales: Doran, James, Canty, David, Dempsey, Karen, Cass, Alan, Kangaharan, Nadarajah, Remenyi, Bo, Brunsdon, Georgie, McDonald, Malcolm, Heal, Clare, Wang, Zhiqiang, Royse, Colin, Royse, Alistair, Mein, Jacqueline, Gray, Nigel, Bennetts, Jayme, Baker, Robert A, Stewart, Maida, Sutcliffe, Steven, Reeves, Benjamin, Doran, Upasna, Rankine, Patricia, Fejo, Richard, Heenan, Elisabeth, Jalota, Ripudaman, Ilton, Marcus, Roberts-Thomson, Ross, King, Jason, Wyber, Rosemary, Doran, Jonathan, Webster, Andrew, Hanson, Joshua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10040039/
https://www.ncbi.nlm.nih.gov/pubmed/36963786
http://dx.doi.org/10.1136/bmjgh-2023-011763
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author Doran, James
Canty, David
Dempsey, Karen
Cass, Alan
Kangaharan, Nadarajah
Remenyi, Bo
Brunsdon, Georgie
McDonald, Malcolm
Heal, Clare
Wang, Zhiqiang
Royse, Colin
Royse, Alistair
Mein, Jacqueline
Gray, Nigel
Bennetts, Jayme
Baker, Robert A
Stewart, Maida
Sutcliffe, Steven
Reeves, Benjamin
Doran, Upasna
Rankine, Patricia
Fejo, Richard
Heenan, Elisabeth
Jalota, Ripudaman
Ilton, Marcus
Roberts-Thomson, Ross
King, Jason
Wyber, Rosemary
Doran, Jonathan
Webster, Andrew
Hanson, Joshua
author_facet Doran, James
Canty, David
Dempsey, Karen
Cass, Alan
Kangaharan, Nadarajah
Remenyi, Bo
Brunsdon, Georgie
McDonald, Malcolm
Heal, Clare
Wang, Zhiqiang
Royse, Colin
Royse, Alistair
Mein, Jacqueline
Gray, Nigel
Bennetts, Jayme
Baker, Robert A
Stewart, Maida
Sutcliffe, Steven
Reeves, Benjamin
Doran, Upasna
Rankine, Patricia
Fejo, Richard
Heenan, Elisabeth
Jalota, Ripudaman
Ilton, Marcus
Roberts-Thomson, Ross
King, Jason
Wyber, Rosemary
Doran, Jonathan
Webster, Andrew
Hanson, Joshua
author_sort Doran, James
collection PubMed
description BACKGROUND: Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival. METHODS: A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis. FINDINGS: The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18–42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4–12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p<0.001). Preoperative chronic kidney disease (HR 6.5 (95% CI: 3.0 to 14.0) p≤0.001)), coronary artery disease (HR 3.3 (95% CI: 1.3 to 8.4) p=0.012) and pulmonary artery systolic pressure>50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death. INTERPRETATION: Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes.
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spelling pubmed-100400392023-03-27 Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained? Doran, James Canty, David Dempsey, Karen Cass, Alan Kangaharan, Nadarajah Remenyi, Bo Brunsdon, Georgie McDonald, Malcolm Heal, Clare Wang, Zhiqiang Royse, Colin Royse, Alistair Mein, Jacqueline Gray, Nigel Bennetts, Jayme Baker, Robert A Stewart, Maida Sutcliffe, Steven Reeves, Benjamin Doran, Upasna Rankine, Patricia Fejo, Richard Heenan, Elisabeth Jalota, Ripudaman Ilton, Marcus Roberts-Thomson, Ross King, Jason Wyber, Rosemary Doran, Jonathan Webster, Andrew Hanson, Joshua BMJ Glob Health Original Research BACKGROUND: Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival. METHODS: A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis. FINDINGS: The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18–42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4–12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p<0.001). Preoperative chronic kidney disease (HR 6.5 (95% CI: 3.0 to 14.0) p≤0.001)), coronary artery disease (HR 3.3 (95% CI: 1.3 to 8.4) p=0.012) and pulmonary artery systolic pressure>50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death. INTERPRETATION: Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes. BMJ Publishing Group 2023-03-24 /pmc/articles/PMC10040039/ /pubmed/36963786 http://dx.doi.org/10.1136/bmjgh-2023-011763 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Doran, James
Canty, David
Dempsey, Karen
Cass, Alan
Kangaharan, Nadarajah
Remenyi, Bo
Brunsdon, Georgie
McDonald, Malcolm
Heal, Clare
Wang, Zhiqiang
Royse, Colin
Royse, Alistair
Mein, Jacqueline
Gray, Nigel
Bennetts, Jayme
Baker, Robert A
Stewart, Maida
Sutcliffe, Steven
Reeves, Benjamin
Doran, Upasna
Rankine, Patricia
Fejo, Richard
Heenan, Elisabeth
Jalota, Ripudaman
Ilton, Marcus
Roberts-Thomson, Ross
King, Jason
Wyber, Rosemary
Doran, Jonathan
Webster, Andrew
Hanson, Joshua
Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
title Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
title_full Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
title_fullStr Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
title_full_unstemmed Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
title_short Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
title_sort surgery for rheumatic heart disease in the northern territory, australia, 1997–2016: what have we gained?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10040039/
https://www.ncbi.nlm.nih.gov/pubmed/36963786
http://dx.doi.org/10.1136/bmjgh-2023-011763
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