title: Experience with cardiac valve operations in Cape York Peninsula and the Torres Strait Islands, Australia.
abstract: OBJECTIVE
  To describe the outcome of valve surgery, for rheumatic heart disease (RHD) and non-RHD, in residents of Cape York Peninsula and the Torres Strait Islands referred to the Cairns Base Hospital specialist outreach service.
  
  
  METHODS
  Retrospective review of medical records on all patients residing in the outreach area who had surgery for valvular heart disease between 1 January 1992 and 31 December 2004.
  
  
  METHODS
  Operation type and perioperative characteristics; 5- and 10-year survival rates; reoperation rates; complications.
  
  
  RESULTS
  Forty-seven patients met the selection criteria; the median age was 40 years (range, 4-76 years); and 39 patients were Indigenous. RHD was the predominant cause of valve dysfunction (30/47 patients). Thirty-seven patients had valve replacements, six had valve repair and four had balloon valvotomy as the initial procedure. There were three bleeding complications, two episodes of operated valve endocarditis, and six embolic complications. There were nine valve-related deaths (six in the first 5 years). At 5 years, all seven patients who had had valve repair or balloon valvotomy were alive. Seven of the 47 patients required reoperation. Survival analysis showed freedom from valve-related deaths to be 83% (95% CI, 66%-92%) at 5 years and 61% (95% CI, 33%-80%) at 10 years. Freedom from reoperation at 5 years was 88% (95% CI, 71%-95%). Among the 30 patients with RHD, freedom from valve-related death was 80% (95% CI, 60%-92%) at 5 years and 52% (95% CI, 21%-75%) at 10 years. In patients with RHD, freedom from reoperation at 5 years was 87% (95% CI, 65%-96%).
  
  
  CONCLUSIONS
  Valvular heart disease results in substantial morbidity and mortality, despite intervention. Efforts need to focus on prevention of rheumatic fever and closer follow-up.
authors.affiliation: Department of Cardiology, Cairns Base Hospital, Cairns, QLD. cherubina77@hotmail.com
authors.forename: Anna
authors.initials: A
authors.lastname: McLean
authors.forename: Michael
authors.initials: M
authors.lastname: Waters
authors.forename: Emma
authors.initials: E
authors.lastname: Spencer
authors.forename: Clive
authors.initials: C
authors.lastname: Hadfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003159:Community-Institutional Relations; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D044382:Population Groups / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis