Flinders Medical Centre, Adelaide, SA, Australia.
Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia.
Heart Lung Circ. 2019 Jul;28(7):1102-1111. doi: 10.1016/j.hlc.2018.05.198. Epub 2018 Jul 30.
Rheumatic heart disease often leads to valve surgery at a young age in our Indigenous population. Anticoagulation can be problematic and therefore repeat surgery to replace degenerated bioprosthetic valves is common. We sought to examine outcomes following redo valve surgery in this population.
Data from our institutional database was reviewed from 1992 to 2017. During this period, 82 redo valve surgeries were performed in 73 patients identifying as Aboriginal and Torres Strait Islander. We compared this study group to Indigenous patients undergoing primary valve surgery (n=389) and non-Indigenous patients undergoing redo valve surgery (n=154).
Redo patients had a median age of 29.5 years (IQR 24, 44), 59% were female, and they had significant comorbidities. The 30-day mortality in this cohort was 6% (EuroSCORE II 3.57), and they had significant morbidity. The median time to repeat surgery in those who had previous mitral valve surgery was 6.3 years, with no difference between mitral valve repair or replacement at the index procedure. Compared to non-Indigenous patients undergoing redo valve surgery, the Indigenous patients were significantly younger with higher left ventricular function but a greater proportion of pulmonary hypertension. There were no significant differences in short-term outcomes. Compared to Indigenous patients undergoing primary valve surgery, the Indigenous redo patients were significantly younger with more co-morbidities. There was no difference in 30-day mortality, but the redo patients did have significantly greater resource utilisation (increased hospital and intensive care unit (ICU) lengths of stay, ventilation and blood transfusion) and poorer long-term survival.
Indigenous patients presenting for redo valve surgery represent a complex and comorbid group of patients, with outcomes worse than expected in a young population, albeit comparable within study groups. Time from original surgery was short at 6 years, and thus a strategy must be in place in terms of planning future surgeries in this cohort of predominantly young rheumatic heart disease patients.
风湿性心脏病在我们的原住民群体中常常导致年轻时进行瓣膜手术。抗凝可能会出现问题，因此，更换退化的生物瓣再次手术很常见。我们试图研究该人群再次瓣膜手术后的结果。
我们从 1992 年至 2017 年的机构数据库中检索数据。在此期间，在 73 名被确定为土著和托雷斯海峡岛民的患者中进行了 82 例再次瓣膜手术。我们将该研究组与进行原发性瓣膜手术的土著患者（n=389）和进行再次瓣膜手术的非土著患者（n=154）进行了比较。
再次手术患者的中位年龄为 29.5 岁（IQR 24，44），59%为女性，且合并症严重。该队列的 30 天死亡率为 6%（EuroSCORE II 3.57），且发病率高。在先前接受过二尖瓣手术的患者中，再次手术的中位时间为 6.3 年，而指数手术时二尖瓣修复或置换无差异。与进行再次瓣膜手术的非土著患者相比，土著患者明显更年轻，左心室功能更高，但肺动脉高压的比例更高。短期结果无显著差异。与进行原发性瓣膜手术的土著患者相比，再次手术的土著患者明显更年轻，合并症更多。30 天死亡率无差异，但再次手术患者的资源利用（住院和重症监护病房（ICU）的住院时间、通气和输血）显著增加，长期生存情况较差。
再次接受瓣膜手术的土著患者是一组复杂且合并症多的患者，尽管在研究组内，但其在年轻人群中的结果比预期的更差。从原始手术到再次手术的时间很短，只有 6 年，因此必须为该主要为年轻风湿性心脏病患者的队列制定未来手术的策略。
