title: Short- and long-term outcomes after valve replacement surgery for rheumatic heart disease in the South Pacific, conducted by a fly-in/fly-out humanitarian surgical team: a 20-year retrospective study for the years 1991 to 2011.
abstract: OBJECTIVE
  Fiji has one of the highest rates of rheumatic heart disease in the world. Humanitarian fly-in/fly-out surgical teams, including Open Heart International, have been conducting valve replacement surgery in Fiji since 1991. We sought to determine the short- and long-term outcomes of valve replacement for rheumatic heart disease.
  
  
  METHODS
  The Open Heart International team performed surgery on 167 patients from 1991 to 2011. Complete follow-up data to death or last evaluation on 149 patients (89.2%) and morbidity data for 152 patients (91%) were extracted from medical records.
  
  
  RESULTS
  Patients' average age at the time of surgery was 26.1 years, with the majority being female (63.5%). Valves replaced were isolated mitral valves (52%), isolated aortic valves (19%), and multiple valves (29%). The cumulative mortality rate at 30, 60, and 90 days and at 1, 5, and 10 years was 2.4%, 6.0%, 8.4%, 12.0%, 19.8%, and 23.9%, respectively. Major adverse valve-related events-free survival was 10.1 years (95% confidence interval [CI], 8.32-11.94). After adjusting for confounders, female patients were 3.03 times more likely to die postoperatively than male patients (odds ratio [OR], 3.03; 95% CI, 1.23-7.69). Patients undergoing isolated valve replacement were less likely to have a morbidity event than those undergoing multiple valve replacement (isolated mitral 67% less likely [OR, 0.33; 95% CI, 0.12-0.93] and isolated aortic 76% less likely [OR, 0.34; 95% CI, 0.06-0.96]).
  
  
  CONCLUSIONS
  The majority of people undergoing valve replacement for rheumatic heart disease have good outcomes. Mortality and morbidity rates at 1 and 5 years, particularly for female patients, are cause for concern and indicate a need for evaluation of resources toward systematic long-term postoperative surveillance and medical management.
authors.affiliation: Level 9, Cardiothoracic Surgical and Medical Telemetry Unit, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia. Electronic address: linda.tm@sah.org.au.
authors.forename: Linda
authors.initials: L
authors.lastname: Thomson Mangnall
authors.affiliation: Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Sibbritt
authors.affiliation: Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fry
authors.affiliation: Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D064870:Air Travel; D000533:Altruism; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005367:Fiji; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008493:Medical Missions; D015999:Multivariate Analysis; D016017:Odds Ratio; D010348:Patient Care Team; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult