RHD surgery

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. The main options for surgical management of RHD are:

  • Balloon valvotomy, which can be used to treat mitral stenosis. This operation can be 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 mitral valve (RHD Australia et al. 2012, 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.

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.

Surgery among all people with RHD

Since the commencement of record keeping by the registers, 1,725 RHD related surgeries have been recorded for 1,277 individuals. More than three-quarters (78%, 1,340) of these surgeries occurred in Indigenous Australians. The following sections focus on surgeries performed on Indigenous Australians with RHD.

Surgery in Indigenous Australians with RHD

In 2013–2017, 322 Indigenous Australians with RHD underwent 350 surgery events. For analysis purposes, a surgical event was included regardless of the year of RHD diagnosis, acknowledging that jursidicitons have been collecting data for different lengths of time (Box 1). The majority of people had one surgery while 23 people had up to 4 surgeries. Around half of these surgeries were in cases from the NT (176 surgical events), and one-third (112) from Qld.

Figure 3: Number of surgical events among Indigenous Australians with RHD, by state and territory, 2013–2017

The vertical bar chart shows the distribution of Indigenous RHD cases who had a surgical event from 2013–2017 by state and territory. The number of surgeries was greatest in NT, which has the greatest number of cases.

Source: AIHW analysis of National Rheumatic Heart Disease data collection.

Just over three quarters of all surgical events among Indigenous Australians with RHD occurred in people aged less than 45 years (270 surgical events), of which 42 were in children aged 5–14 (12%). Only 23% of surgical events were for those aged 45 and over (80 surgical events). Two-thirds of all surgical events (234) were in females. Across age categories, between 64% and 70% of surgery events occurred in females. The sex distribution of surgical events is similar to the distribution of people living with RHD.

Figure 4: Number of surgical events among Indigenous Australians with RHD, by age group, 2013–2017

The vertical bar chart shows the age distribution of Indigenous RHD cases who had a surgical event from 2013–2017. The number of surgeries increased was least in children 5–14 years old and most in adults aged 25–34 years old. More information is located in the data tables, RHD Table 19.

Notes

  1. There were no people who received surgery for RHD when aged 0–4 during 2013–2017.
  2. This shows the age at surgery of the 350 surgical events 2013–2017. Individuals who had more than one surgery are included multiple times as an individual could have more than one surgery in the period.

Source: AIHW analysis of National Rheumatic Heart Disease data collection.

In 2013–2017, during the 350 surgical events amongst Indigenous RHD cases, there were 477 individual procedures performed. There were 89 people who had 2 different surgical procedures, 18 who had 3 and 9 who had between 4 and 6 procedures. Multiple procedures could occur in one surgery, or over multiple surgeries.

Nearly 300 valve replacement procedures (62%) occurred. Among these, replacement with a mechanical valve was more common than with a bioprosthetic valve. A quarter of procedures involved the aortic valve (122 procedures). 

Table 6: Proportion of surgical procedures by surgery type and valve among Indigenous Australians, 2013–2017

Procedure type

Mitral valve

Aortic valve

Tricuspid valve

Total per cent

Total number

Repair, including open valvuloplasty

26.9

11.5

73.2

28.5

136

Replacement—mechanical valve

37.9

40.2

7.1

34.8

166

Replacement—bioprosthetic valve

24.2

42.6

12.5

27.5

131

Percutaneous balloon valvuloplasty

4.0

0.8

1.8

2.9

14

Other or unknown type(a) 7.0 4.9 5.4 6.3 30

Total per cent

62.5

25.6

11.7

100.0

477

Total number

298

122

56

. .

477

  1. Includes 28 not stated or unknown surgery types, 1 surgery of the pulmonary valve and 2 Ross procedure surgeries.

Note: The NT data groups valvuloplasties with repairs.

Source: AIHW analysis of National Rheumatic Heart Disease data collection.

Surgery for RHD

322 Indigenous Australians underwent surgery for RHD in 2013–2017. Three-hundred and fifty surgical events were recorded, comprising 477 individual procedures. Surgery was most common in people less than 45 years and in females.   

References

RHD Australia, (ARF/RHD writing group), National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand 2012. The Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd 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. J Heart Valve Dis 22(3):333–9.