title: A review of outcome following 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 younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing outcome following surgery for RHD.
  
  
  METHODS
  The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to assess outcomes following surgical procedures for RHD and non-RHD valvular disease. The association with demographics, co-morbidities, pre-operative status, valve(s) affected and operative procedure was evaluated.
  
  
  RESULTS
  Outcome of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients had longer ventilation, experienced fewer strokes and had more readmissions to hospital and anticoagulant complications. Mortality following RHD surgery at 30 days was 3.1% (95% CI 2.2 - 4.3), 5 years 15.3% (11.7 - 19.5) and 10 years 25.0% (10.7 - 44.9). Mortality following non-RHD surgery at 30 days was 4.3% (95% CI 3.9 - 4.6), 5 years 17.6% (16.4 - 18.9) and 10 years 39.4% (33.0 - 46.1). Factors independently associated with poorer longer term survival following RHD surgery included older age (OR1.03/additional year, 95% CI 1.01 - 1.05), concomitant diabetes (OR 1.7, 95% CI 1.1 - 2.5) and chronic kidney disease (1.9, 1.2 - 2.9), longer invasive ventilation time (OR 1.7 if greater than median value, 1.1- 2.9) and prolonged stay in hospital (1.02/additional day, 1.01 - 1.03). Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians.
  
  
  CONCLUSIONS
  In a large prospective cohort study we have demonstrated survival following RHD valve surgery in Australia is comparable to earlier studies. Patients with diabetes and chronic kidney disease, were at particular risk of poorer long-term survival. Unlike earlier studies we did not find pre-existing atrial fibrillation, being an Indigenous Australian or the nature of the underlying valve lesion were independent predictors of survival.
authors.affiliation: Baker IDI, Melbourne, VIC, 3004, Australia. Anne.Russell@monash.edu.|School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Anne.Russell@monash.edu.
authors.forename: E Anne
authors.initials: EA
authors.lastname: Russell
authors.affiliation: School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Lavinia.Tran@monash.edu.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Tran
authors.affiliation: Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, South Australia. Rob.Baker@health.sa.gov.au.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.affiliation: Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, South Australia. Jayme.Bennetts@health.sa.gov.au.|Department of Surgery, School of Medicine, Flinders University, Adelaide, South Australia. Jayme.Bennetts@health.sa.gov.au.
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Bennetts
authors.affiliation: Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, South Australia. Alex.Brown@sahmri.com.|School of Population Health, University of South Australia, Adelaide, South Australia. Alex.Brown@sahmri.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
authors.affiliation: School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. christopher.reid@curtin.edu.au.|School of Public Health, Curtin University, Perth, Western Australia. christopher.reid@curtin.edu.au.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Director of Surgery, Department of Cardiothoracic Surgery, Townsville Hospital, Queensland, Australia. Robert.Tam@health.qld.gov.au.
authors.forename: Robert
authors.initials: R
authors.lastname: Tam
authors.affiliation: Prince of Wales Hospital, Randwick, NSW, Australia. Warren.Walsh@ehc.com.au.
authors.forename: Warren F
authors.initials: WF
authors.lastname: Walsh
authors.affiliation: Baker IDI, Melbourne, VIC, 3004, Australia. Graeme.Maguire@bakeridi.edu.au.|School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Graeme.Maguire@bakeridi.edu.au.|School of Medicine, James Cook University, Cairns, QLD, Australia. Graeme.Maguire@bakeridi.edu.au.
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Maguire
mesh_terms: D000367:Age Factors; D000368:Aged; D001315:Australia / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011446:Prospective Studies; D012121:Respiration, Artificial; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome