Peri-operative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital
Date
2022
Authors
Tabane, Tebogo Mokotong-Mosekama
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Abstract
Background
The distribution and determinants of heart disease vary greatly between developed countries and Sub-Saharan Africa, where rheumatic heart disease (RHD) remains a major public health issue. Studies from across Africa show that RHD, specifically of the mitral valve, is the main cause of morbidity and mortality from valvular heart surgery. Data on mitral valve surgery outcomes in South Africa are however limited. The aim of this study was to describe the peri-operative outcomes of patients that have undergone mitral valve surgery at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).
Methods
All patients above the age of 18 years who underwent mitral valve surgery at CMJAH between 1 January 2015 and 31 December 2018 were retrospectively included in the study. Cardiac Intensive Care Unit files including anaesthesia charts were assessed to describe pre-operative, intra-operative and post-operative data of each patient. Pre-operative data included patient demographic information and comorbidities. Intra-operative data included aortic clamp and bypass times. Post-operative variables included outcomes such as sepsis, bleeding, re-operation
and the development of acute kidney injury (AKI). The pre-operative, intraoperative and post-operative outcomes were then compared to determine the effect each variable had on post-operative mortality.
Results
Two hundred and seventeen patients underwent mitral valve surgery at CMJAH between 1 January 2015 and 31 December 2018. Four of the patients had incomplete files. RHD was the predominant primary aetiology for mitral valve surgery. The mortality rate in this study was 6,10%. Pre-operative findings that contributed to mortality were: EuroSCORE II > 2%, pre-operative ventilation, dialysis dependence, pre-operative inotropic support, chronic obstructive pulmonary disease, congestive cardiac failure, renal insufficiency, low ejection fraction % and New York Heart Association ≥III. Post-operative findings that contributed to increased mortality were prolonged mechanical ventilation, pneumonia, re-operation, AKI, sepsis, bleeding and transfusion. Increased aortic clamping and cardio-pulmonary bypass times increased the risk of prolonged mechanical ventilation, re-operations, use of pacemakers, AKI and bleeding.
Description
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesia to the Faculty of Health Sciences, School of Clinical Medicine, University of
Witwatersrand, Johannesburg, 2021