RHD surgery

For analysis purposes, a surgical event was included regardless of the year of RHD diagnosis, acknowledging that the years for which jurisdictions have been collecting data vary.
Refer to Jurisdictional RHD control programs and registers for more information.

RHD leads to damage to the heart’s valves—the mitral, aortic, pulmonary and tricuspid valves. The damaged valves may need surgery so they can be replaced or repaired. An individual may have surgical events more than once on damaged valves, and may have multiple procedures in one surgical event—that is, multiple valves repaired or replaced in a single surgery.

Since the commencement of registers, there were 1,864 RHD related surgeries recorded for 1,432 individuals. Of these surgeries, 76% occurred in Indigenous Australians (1,416). These figures reflect only those surgeries that were reported to the registers, and may not necessarily include all RHD-related surgery undertaken.

Box 5: Surgical procedures

Balloon valvotomy

Can be used to treat mitral stenosis. Performed by threading a deflated balloon on wires up to the heart from a cut in the groin. The narrowed mitral valve is opened by gently inflating a balloon inside the valve. The small incision reduces costs and complications compared with open surgical repair.

Valve repair

Involves repairing the heart valve shape and function to allow for normal blood flow. It usually involves open heart surgery. Repair generally offers the best outcomes for children and adults, particularly for the mitral valve (RHD Australia 2020, Wang et al. 2013).

Valve replacement

Involves removing the damaged valve and replacing it with a mechanical prosthetic (metallic valve) or bioprosthetic valve (tissue valve from animal or human donors). This generally involves open heart surgery.

In 2014–2018, 349 Aboriginal and Torres Strait Islander people underwent 364 surgical events. Of these individuals:

  • 336 had surgery once, 12 had surgery twice, 1 had 3 or more surgeries
  • 185 were from the Northern Territory (53%)
  • 100 were from Queensland (29%)
  • 236 were female (68%).

The sex distribution of people undergoing RHD surgery is similar to the distribution of people living with RHD.

Figure 2: Number of Indigenous Australians who had RHD surgery in 20142018 

Note: Data only available for Qld, WA, SA and NT.

Chart: AIHW. Source: AIHW analysis of the National Rheumatic Heart Disease Data Collection.

Surgery by age

In 2014–2018, of the 364 surgical events among Indigenous Australians, most occurred among those aged:

  • 25–44 years, with 152 surgeries (42%)
  • 45 and over, with 89 surgeries (24%).

During the same period, no children aged less than 5 had surgery for RHD.

Surgical events among Indigenous Australians with RHD. A vertical bar graph showing surgical events in 2014-2018 among Indigenous Australians with RHD. The bars show the number of surgical events for males, females and all persons grouped by age group. The most surgical events for all persons were among those aged 25-44 years (152).

Visualisation not available for printing

Surgery type

More than one procedure can be performed during a surgical event, and more than one valve can be involved.

During the 364 surgical events for Indigenous Australians in 2014–2018, 494 individual procedures were performed. The mitral valve was most frequently operated on, with 310 procedures (63%). During the same period, 309 procedures (63%) involved valve replacement. Among these, replacement with a mechanical valve was more common than with a bioprosthetic valve. Almost one-third of procedures (156) involved repairing a valve.

Surgical procedures by surgery type and affected valve among Indigenous Australians with RHD. A horizontal bar graph showing the proportion of surgical procedures in 2014-2018, by surgery type and affected heart valve, among Indigenous Australians with RHD. The mitral valve was the most commonly affected valve - involved with 63% of all surgical procedures. 

Visualisation not available for printing

References

RHD Australia, (ARF/RHD writing group). The 2020 Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edn). Northern Territory: RHD Australia, Menzies School of Health Research.

Wang Z, Zhou C, Gu H, Zheng Z & Hu S 2013. Mitral valve repair versus replacement in patients with rheumatic heart disease. Journal of Heart Valve Disease. 22(3):333–9.