Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand.
ANZ J Surg. 2022 May;92(5):1060-1065. doi: 10.1111/ans.17685. Epub 2022 Apr 11.
Rheumatic heart disease (RHD) remains an important cause of morbidity and mortality in New Zealand. Factors associated with the choice of surgical treatment for advanced RHD in young adults are poorly understood. We sought to review our local experience with the surgical management of young adults with rheumatic mitral valvular disease.
From 2003 to 2016, all patients aged 15-24 years undergoing mitral valve surgery for rheumatic disease at Auckland City Hospital, New Zealand were retrospectively reviewed.
During the 13-year study period, 73 young adults underwent mitral surgery; 85% were Maori or Pacific Islanders. Mitral repair was performed in 32 patients and replacement in 41 patients. Isolated mitral valve surgery was performed in 36%, double valve procedures in 47%, and triple valve procedures in 17% of patients. The 30-day mortality rate and stroke rate were 1.4% and 2.7% respectively. The medium-term mortality rate was 11.9% across a mean follow-up of 6 years (6.9% in the repair group, 15.8% in the replacement group, p = 0.25). There were increased bleeding complications (p = 0.04) in patients with mechanical mitral valve replacement. For patients on warfarin, across medium-term follow-up, the INR was in the therapeutic range only 23% of the time.
Most young adults in New Zealand with severe RHD requiring surgery are of indigenous Maori or Pacific Island ethnicity. There is a trend towards improved survival with mitral repair. There is a significant tendency towards increased bleeding complications in patients on warfarin for mechanical mitral replacement. Warfarin compliance is poor.
风湿性心脏病（RHD）仍然是新西兰发病率和死亡率的重要原因。年轻人中晚期 RHD 手术治疗选择的相关因素尚不清楚。我们试图回顾我们在治疗年轻成年人风湿性二尖瓣疾病的手术管理方面的本地经验。
从 2003 年至 2016 年，新西兰奥克兰市医院对所有 15-24 岁因风湿性疾病接受二尖瓣手术的年轻患者进行了回顾性分析。
在 13 年的研究期间，73 名年轻人因风湿性疾病接受了二尖瓣手术；85%为毛利人或太平洋岛民。32 名患者行二尖瓣修复术，41 名患者行二尖瓣置换术。单纯二尖瓣手术占 36%，双瓣手术占 47%，三瓣手术占 17%。30 天死亡率和卒中率分别为 1.4%和 2.7%。平均随访 6 年后，中期死亡率为 11.9%（修复组为 6.9%，置换组为 15.8%，p=0.25）。机械二尖瓣置换术患者出血并发症增加（p=0.04）。对于服用华法林的患者，在中期随访中，INR 仅在 23%的时间处于治疗范围内。
新西兰大多数需要手术治疗的严重风湿性心脏病的年轻成年人都具有毛利人或太平洋岛民的原住民血统。二尖瓣修复术的生存率有提高的趋势。服用华法林的机械二尖瓣置换术患者出血并发症的发生率显著增加。华法林的依从性很差。
