Outcomes After Concomitant Mitral and Aortic Rheumatic Valve Surgery in Young People ^†

Background: Rheumatic heart disease (RHD) continues to disproportionately affect young Māori and Pacific Peoples in Aotearoa New Zealand (NZ). Concomitant aortic and mitral valve (AMV) disease is more common from the second decade, and little is known about long-term outcomes after surgery in young people. Methods: This was a single-centre retrospective cohort study with participants aged < 18 years who had concomitant AMV surgery for RHD in NZ between 2005 and 2019. Baseline, early (6–24 months postoperative) and late (>2 years postoperative or immediately prior to reoperation) data were collected. Left ventricular (LV) dysfunction was defined as ejection fraction (LVEF) < 55% or shortening fraction (LVFS) < 27%. Results: A total of 98 patients were included, with a median age of 11.5 years (4–17 years) and median weight of 54 kg (15–118 kg). Two predominant operations—mitral and aortic valve repairs (47%) and mitral valve repair with aortic valve homograft replacement (41%)—were performed. Preoperative LV dysfunction was present in 28% of patients. The 30-day mortality was zero. Overall mortality was 7/98, with a median time from surgery to death of 10 years. The reoperation rate was 46/98 (47%) after a median of 5 years (1 month–16 years), and 8% underwent a second reoperation. Late follow-up data: 25/78 (32%) had LV dysfunction—8 of the 25 had preoperative LV dysfunction which persisted, and 17/25 had new dysfunction. Late complications (infective endocarditis, thromboembolic event, arrhythmia, LV dysfunction, death) occurred in 63/98 (64%) patients. Conclusions: This is the largest study assessing outcomes after surgery for mixed rheumatic AMV disease in young people globally. This cohort of young people are faced with high rates of reoperation, and almost two thirds are faced with late complications.