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Early and long-term outcomes of mitral valve replacement with mechanical valve in rheumatic heart disease

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Rheumatic fever and rheumatic heart disease is endemic in India. Mitral valve replacement with mechanical valve is the commonest surgical procedure performed in rheumatic heart disease (RHD). However, there are no studies reporting the long-term outcomes of mechanical mitral valve replacement in rheumatic heart disease from India.

Objective

The primary objective of the study was to look at the long-term survival following mechanical mitral valve replacement in RHD. The secondary objectives included follow up complications and event-free survival.

Methods

For this study, 238 patients who underwent mitral valve replacement with TTK Chitra™ valve from 1st January 2006 to 31st December 2018 for RHD were included for analysis and reporting. The median follow-up period was 3371.50 days (9.3 years). Total follow-up was 2044 patient-years.

Results

The mean age of the study population was 39.72 ± 10.48 years (range: 18–68 years). Out of 238 patients operated, 155 patients (65.12%) were alive and 69 patients (28.99%) were dead, and 14 patients (5.88%) were lost to follow-up. The operative mortality was 6 (2.52%) and the follow-up mortality was 63 (26.47%). The reasons for follow-up mortality were cardiac complications in 22 (34.9%) patients, valve-related complications in 18 (28.5%) patients, sudden unexplained death in 13 (20.6%) patients, and non-valve/ non-cardiac death in 10patients (15.8%). The one-year survival was 94.0%, five-year survival was 83.6%, ten-year survival was 70.6% and 15-year survival was 62.9%. During follow-up, valve-related events occurred in 123(52%) patients. The 15-year event-free survival was 33.0%.

Conclusions

The long term outcome of mechanical valve replacement of the mitral valve in RHD patients was less than favorable. Both cardiac complications and mechanical valve related complications reduced their survival.

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Data Availability

Full set of data is available [32].

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Acknowledgements

The authors gratefully acknowledge the funding support of the ICMR, New Delhi for this study. The field support provided by TTK Healthcare Limited., Heart Valve Division in the areas of patient tracking and data collection is also gratefully acknowledged.

Funding

The study was funded by the Indian Council of Medical Research (ICMR), New Delhi (No. 5/4/1–3/2019-NCD-II).

Author information

Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India

    Praveen Kerala Varma, Neethu Krishna, Rohik Micka Radhakrishnan, Rajesh Jose & Kirun Gopal

  2. Department of Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India

    Maniyal Vijayakumar

  3. Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India

    Renjitha Bhaskaran

  4. Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India

    Raman Krishna Kumar

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Contributions

Authors 1 & 2-Contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript.

Authors 3 and 4-Contributed to data collection and performed statistical analysis and designed the figures.

Authors 5,6,7- Helped in data collection, analysis and corrected the final draft.

Author 8-Concieved the idea, analyzed the results, helped in writing and approved the final draft.

Corresponding author

Correspondence to Praveen Kerala Varma.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Varma, P.K., Vijayakumar, M., Krishna, N. et al. Early and long-term outcomes of mitral valve replacement with mechanical valve in rheumatic heart disease. Indian J Thorac Cardiovasc Surg 40, 133–141 (2024). https://doi.org/10.1007/s12055-023-01615-3

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