One Year Follow-up of Rheumatic Heart Disease Patients who Underwent Surgical Mitral Valve Replacement in Sanglah Hospital, Bali

Nabila Natasya ¹, Yasa Ketut Putu ²

¹ Udayana University, Denpasar, Indonesia; ² Cardiovascular, Thoracic and Endovascular Surgery Department, Sanglah Central Hospital - Udayana University, Denpasar, Indonesia;

Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D

Abstract

Introduction: Rheumatic Heart Disease (RHD) prevalence worldwide estimate is 15 million cases which is dominated by developing country (20-30 cases per 1000 subjects). In Indonesia, There's no available data about RHD prevalence. RHD most likely affected mitral valve. Mitral valve replacement is one of the most common procedure performed in RHD patients. This is the first study about 12 months follow up of RHD patients after surgical mitral valve replacement profile in Sanglah Central Hospital, Bali, Indonesia

Method : A single center cohort retrospective study with 1 year follow up, using secondary data accessed with total sampling method from hospital medical report registered from 2012-2017. We exluded data with missing variable, patients with double valve replacement, and patients with lost to follow up. Data analyzed using ANOVA, and calculate risk ratio using chi-square.

Result : a total of 89 RHD patients with severe mitral stenosis who undergone open mitral valve replacement surgery. Most are women(67.6%), age range from 16y/o-61y/o with mean age of 35.7 y/o. The procedure've done are MVR(73%), MVR+TVr(15.7%), and MVR+TVr+LAA ligation(11.2%). Most of the patients (67.3%) using mechanical valve. Mean of time needed for surgery is 5.5 hours, ACC used 1.6 hours, and CPB connected 2.6 hours. Almost all surgery using ACC clamp and CPB in the safety range (<2.30 hours:83.1%; and <4 hours: 92.1%). Paired sample t-test showed mean LVEF before surgery was 59.4% to 59.62(p=0.673) and TAPSE 1.64 cm to 1.82cm year after procedure (p=0.000) with 18% patients died before one year. We found out that women gender(p=0.010;RR=1.52), pulmonary hypertension(p=0.039;RR=1.86), time using ACC(p=0.001;RR=5.2), time connected to the CPB(p=0.002;RR=11.4), bioprosthesis valve(p=0.038;RR=2.05), and pre-op LVEF(p=0.000;RR=6.08) affecting mortality in men.

Conclusion : in RHD patients undergoing mitral valve replacement, female gender, pulmonary hypertension status, pre-op LVEF, bioprosthesis valve and time for using ACC also CPB can giving higher risk for mortality within a year after surgery.