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Outcomes After Surgery for Isolated Rheumatic Aortic Valve Disease in the Young: Preoperative Left Ventricular
Hilary A Hardefeldt1, Steven Kiyokawa2, Thomas L Gentles2,3
1Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Summary
Pediatric patients with rheumatic aortic valve disease undergoing surgery face higher mortality risks if they have preoperative left ventricular (LV) dysfunction. This risk is amplified by body surface area and leads to frequent reoperations and long-term complications.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Valvular Heart Disease
Background:
- Rheumatic aortic valvular disease significantly impacts young patients.
- Understanding surgical indications and outcomes in this population is crucial.
Purpose of the Study:
- To analyze the outcomes of cardiac surgery for rheumatic aortic valve disease in patients under 18.
- To identify risk factors for mortality and complications in this cohort.
Main Methods:
- Retrospective cohort study of 39 patients (<18 years) undergoing surgery for isolated rheumatic aortic valve disease (2000-2019).
- Data collected on baseline, intermediate, and late follow-up, including left ventricular (LV) function.
- LV dysfunction defined as LV ejection fraction <55% or LV shortening fraction <27%.
Main Results:
- Overall mortality was 20% (8/39), with 43% (17/39) requiring reoperation.
- Preoperative LV dysfunction significantly increased the risk of death (HR 13.3, P=.003), an effect amplified by body surface area (BSA).
- High rates of persistent LV dysfunction (53% at late follow-up) and valve-related complications were observed.
Conclusions:
- Preoperative LV dysfunction is a critical predictor of mortality in pediatric patients undergoing rheumatic aortic valve surgery.
- Higher BSA exacerbates the mortality risk associated with LV dysfunction.
- The study highlights a high incidence of reoperations and late complications, necessitating long-term monitoring.
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