Determinants of prolonged length of hospital stay after cardiac surgery: impact of rheumatic heart disease

Background. Renal impairment increases the risk of cardiovascular events and perioperative complications in patients with heart valve disease. This study aimed to determine the perioperative benefit of statin treatment related to baseline renal function in patients with rheumatic heart disease (RHD) who had cardiac surgery. Methods and Results. We performed a retrospective study on 136 patients with RHD who underwent valve replacement surgery. The mean age of the patients was 56.2 years, 59.6% were female, 8.8% patients had diabetes mellitus, and 27.2% of patients had hypertension. Overall, 3 patients died, 2 underwent reoperation, and 25 underwent thoracentesis during the study period. For patients with renal impairment, there was a higher risk of thoracic puncture (odds ratio [OR]: 3.33; 95% confidence interval [CI]: 1.36, 8.11; P<0.01) and a longer time of drainage (difference in means: 1; 95% CI: 0.88, 1.12; P<0.01), intensive care unit (ICU) stay (difference in means: 0.2; 95% CI: 0.17, 0.23; P=0.02), and hospital stay (difference in means: 6.6; 95% CI: 6.15, 7.05; P<0.01) compared with normal renal function. Furthermore, statins were associated with a reduction in drainage time (difference in means: −1.50; 95% CI: −1.86, −1.14; P=0.02), ICU stay (difference in means: −0.30; 95% CI: −0.40, −0.20; P=0.05), and hospital stay (difference in means: −5.40; 95% CI: −6.57, −4.23; P<0.01) in patients with renal impairment (interaction, P≤0.05 for all), but not in those with normal renal function. Conclusion. Statins have a greater clinical benefit in perioperative cardiac surgery with renal impairment. Statins are associated with a comparatively lower risk of thoracic puncture, as well as a reduced trend toward a reduction in drainage time, ICU stay, and hospital stay.

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Cardiac surgery for advanced rheumatic heart disease in Rwanda

The Lancet Global Health ◽

10.1016/s2214-109x(14)70022-1 ◽

2014 ◽

Vol 2 (3) ◽

pp. e141-e142 ◽

Cited By ~ 7

Author(s):

JaBaris D Swain ◽

Joseph Mucumbisti ◽

Emmanuel Rusingiza ◽

R Morton Bolman ◽

Agnes Binagwaho

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Rheumatic Heart

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Effect of cardiac surgery on maternal and perinatal outcome in rheumatic heart disease with pregnancy: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180905 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1123

Author(s):

Vikas Yadav ◽

J. B. Sharma ◽

Garima Kachhawa ◽

Alka Kriplani ◽

Reeta Mahey ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Valve Replacement ◽

Perinatal Outcome ◽

Surgery Group ◽

Group 3 ◽

Group 2 ◽

Rheumatic Heart ◽

Group 1

Background: Rheumatic heart disease remains the commonest heart disease in India with mitral stenosis being the most common lesion and is associated with significant maternal and perinatal mortality and morbidity. The objective of this study was to compare maternal and perinatal outcome in women with rheumatic heart valvular disease who had no surgery or had percutaneous balloon mitral valvuloplasty (PBMV) or had valvular replacement surgery.Methods: It was a retrospective study in 113 women with rheumatic heart disease with various valvular lesion admitted in the hospital in previous 10 years. There were 58 (51.35%) patients without cardiac surgery (Group 1), 24 (21.23%) with PTMC (Group 2) and 31 (27.43%) with valve replacement surgery (Group 3). Maternal and perinatal outcome were compared in three groups.Results: The baseline characteristics were similar in the three group. In cardiac complications New York Heart Association (NYHA) deterioration was significantly higher (24.1%) in non-operated group (Group 1) as compared to Group 2 (12.3%) and Group 3 (16.1%). There was no difference in Group 2 and Group 3. Need of cardiac medication (digoxin) was also highest (67.2%) in Group 1 as compared to Group 2 (24.6%) (p = 0.002) and Group 3 (38.7%) (p = 0.001) but no difference in Group 2 and Group 3. Anticoagulant were given to significantly higher number (54.8% of cases in Group 3 (valve replacement) as compared to Group 1 (3.4%) and Group 2 (12.5%). There was no significant difference in obstetric events and mode of delivery in the three groups. Similarly, there was no difference in fetal outcome in the three groups as regard to mean birth weight, APGAR score, fetal growth restriction, fetal or neonatal death or congenital anomalies in the three groups.Conclusions: Cardiac surgery before or during pregnancy did not significantly improve maternal or perinatal outcome. Only cardiac events and need of medication was reduced with surgery. Hence surgery should be performed judiciously in selected cases.

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Priorities in Cardiac Surgery for Rheumatic Heart Disease

Global Heart ◽

10.1016/j.gheart.2013.08.010 ◽

2013 ◽

Vol 8 (3) ◽

pp. 213 ◽

Cited By ~ 18

Author(s):

Kirsten Finucane ◽

Nigel Wilson

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Rheumatic Heart

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Rheumatic heart disease: The role of global cardiac surgery

Journal of Cardiac Surgery ◽

10.1111/jocs.15597 ◽

2021 ◽

Author(s):

Dominique Vervoort ◽

Manuel J. Antunes ◽

A. Thomas Pezzella

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Rheumatic Heart

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United in earnest: First pilot sites for increased surgical capacity for rheumatic heart disease announced by Cardiac Surgery Intersociety Alliance

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2020.11.183 ◽

2021 ◽

Author(s):

Zachary Obinna Enumah ◽

Ralph Morton Bolman ◽

Peter Zilla ◽

Percy Boateng ◽

Barry Wilson ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Surgical Capacity ◽

Rheumatic Heart

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Rheumatic heart disease in The Gambia: clinical and valvular aspects at presentation and evolution under penicillin prophylaxis

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02308-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lamin E. S. Jaiteh ◽

Lamin Drammeh ◽

Suzanne T. Anderson ◽

John Mendy ◽

Samba Ceesay ◽

...

Keyword(s):

Young Adults ◽

Cardiac Surgery ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Case Fatality ◽

Secondary Prophylaxis ◽

Control Programme ◽

The Gambia ◽

Penicillin Prophylaxis ◽

Rheumatic Heart

Abstract Background Rheumatic heart disease (RHD) remains the leading cause of cardiac-related deaths and disability in children and young adults worldwide. In The Gambia, the RHD burden is thought to be high although no data are available and no control programme is yet implemented. We conducted a pilot study to generate baseline data on the clinical and valvular characteristics of RHD patients at first presentation, adherence to penicillin prophylaxis and the evolution of lesions over time. Methods All patients registered with acute rheumatic fever (ARF) or RHD at two Gambian referral hospitals were invited for a clinical review that included echocardiography. In addition, patients were interviewed about potential risk factors, disease history, and treatment adherence. All clinical and echocardiography information at first presentation and during follow-up was retrieved from medical records. Results Among 255 registered RHD patients, 35 had died, 127 were examined, and 111 confirmed RHD patients were enrolled, 64% of them females. The case fatality rate in 2017 was estimated at 19.6%. At first presentation, median age was 13 years (IQR [9; 18]), 57% patients had late stage heart failure, and 84.1% a pathological heart murmur. Although 53.2% of them reported history of recurrent sore throat, only 32.2% of them had sought medical treatment. A history suggestive of ARF was reported by 48.7% patients out of whom only 15.8% were adequately treated. Two third of the patients (65.5%) to whom it was prescribed were fully adherent to penicillin prophylaxis. Progressive worsening and repeated hospitalisation was experienced by 46.8% of the patients. 17 patients had cardiac surgery, but they represented only 18.1% of the 94 patients estimated eligible for cardiac surgery. Conclusion This study highlights for the first time in The Gambia the devastating consequences of RHD on the health of adolescents and young adults. Our findings suggest a high burden of disease that remains largely undetected and without appropriate secondary prophylaxis. There is a need for the urgent implementation of an effective national RHD control programto decrease the unacceptably high mortality rate, improve case detection and management, and increase community awareness of this disease.

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