Profile of adult patients presenting for rheumatic mitral valve surgery at an academic hospital

Abstract

Background Perioperative morbidity and mortality are increased in patients with rheumatic heart disease. Preoperative risk stratification is imperative for optimisation and better outcome. Methods This was a descriptive, retrospective, contextual study. A consecutive convenience sampling method was used. Eighty-nine patients who underwent mitral valve surgery at Charlotte Maxheke Johannesburg Academic Hospital between January 2014 and December 2015 were enrolled. Results Forty-seven patients presented with mitral regurgitation (MR), 35 had mitral stenosis (MS). Data included two mixed mitral valve disease patients with predominant regurgitation that were classified under the regurgitation group. Forty-five percent (39) had arrhythmias and 49% (42) congestive cardiac failure at presentation for surgery. The overall mean (SD) pulmonary pressure was 57 (20) mmHg and the mean left atrial size was 53 (11) mm. Those with mitral stenosis presented with mean (SD) mitral valve area of 0.9 (0.2) cm². Of the analysed MR patients, 51% presented with left ventricular ejection fraction (LVEF)<60%, and 55% with left ventricular end systolic diameter (LVESD)>40mm. Amongst the analysed MS patients, 59% had mitral valve area <1cm2. A substantial number (49% MR and 54% MS) of collected records were not eligible for analysis and stratification using the American Heart Association/American College of Cardiology Guidelines (ACC/AHA) for Valvular Heart Disease. Of the 24 MR patients analysed utilising the 2014/2017 AHA/ACC guidelines, 13 had a-symptomatic severe mitral regurgitation (Stage C) and 11 symptomatic severe mitral regurgitation (Stage D). One patient had progressive mitral stenosis (Stage B), 8 a-symptomatic severe mitral stenosis (Stage C) and 7 symptomatic severe mitral stenosis (Stage D). Conclusion The majority of the patients presented in Stage C and Stage D of disease progression; however they also presented with concomitant clinical and echocardiographic features that placed them at high risk of perioperative morbidity.