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

Praveen Kerala Varma; Maniyal Vijayakumar; Neethu Krishna; Renjitha Bhaskaran; Rohik Micka Radhakrishnan; Rajesh Jose; Kirun Gopal; Raman Krishna Kumar

doi:10.1007/s12055-023-01615-3

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

Indian J Thorac Cardiovasc Surg. 2024 Mar;40(2):133-141. doi: 10.1007/s12055-023-01615-3. Epub 2023 Oct 18.

Authors

Praveen Kerala Varma¹, Maniyal Vijayakumar², Neethu Krishna¹, Renjitha Bhaskaran³, Rohik Micka Radhakrishnan¹, Rajesh Jose¹, Kirun Gopal¹, Raman Krishna Kumar⁴

Affiliations

¹ Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.
² Department of Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.
³ Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.
⁴ Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.

PMID: 38389758
PMCID: PMC10879478 (available on 2025-03-01)
DOI: 10.1007/s12055-023-01615-3

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.

Keywords: Low -middle income country; Mitral valve replacement; Outcomes; Rheumatic Fever; Rheumatic heart disease; Survival.

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