title: A review of valve surgery for rheumatic heart disease in Australia.
abstract: BACKGROUND
  Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects older non-Indigenous Australians and Aboriginal Australians and/or Torres Strait Islander peoples. Factors associated with the choice of treatment for advanced RHD remain variable and poorly understood.
  
  
  METHODS
  The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. Demographics, co-morbidities, pre-operative status and valve(s) affected were collated and associations with management assessed.
  
  
  RESULTS
  Surgical management of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients were younger, more likely to be female and Indigenous Australian, to have atrial fibrillation (AF) and previous percutaneous balloon valvuloplasty (PBV). Surgery was performed on one valve in 64.5%, two valves in 30.0% and three valves in 5.5%. Factors associated with receipt of mechanical valves in RHD were AF (OR 2.69) and previous PBV (OR 1.98) and valve surgery (OR 3.12). Predictors of valve repair included being Indigenous (OR 3.84) and having fewer valves requiring surgery (OR 0.10). Overall there was a significant increase in the use of mitral bioprosthetic valves over time.
  
  
  CONCLUSIONS
  RHD valve surgery is more common in young, female and Indigenous patients. The use of bioprosthetic valves in RHD is increasing. Given many patients are female and younger, the choice of valve surgery and need for anticoagulation has implications for future management of RHD and related morbidity, pregnancy and lifestyle plans.
authors.forename: Elizabeth Anne
authors.initials: EA
authors.lastname: Russell
authors.forename: Lavinia
authors.initials: L
authors.lastname: Tran
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Bennetts
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
authors.forename: Christopher Michael
authors.initials: CM
authors.lastname: Reid
authors.forename: Robert
authors.initials: R
authors.lastname: Tam
authors.forename: Warren Frederick
authors.initials: WF
authors.lastname: Walsh
authors.affiliation: Baker IDI Central Australia, PO Box 1294, Alice Springs, NT 0811, Australia. Graeme.Maguire@bakeridi.edu.au.
authors.forename: Graeme Paul
authors.initials: GP
authors.lastname: Maguire
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D001705:Bioprosthesis; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants