Heart Valve Surgery in a Young Predominantly Rheumatic Population

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Abstract
Between August 1988G and August 1992G, 802 Saudi patients underwent 1,171 open valve surgical procedures at King Faisal Specialist Hospital and Research Centre (KFSH&RC). The mean age was 32.4 years (range one to 90). The etiology was rheumatic in 66.3.%, congenital in 12.8%, degenerative in 8.7%, infective in 5.9% and ischemic in 2%. The mean preoperative New York Heart Association (NYHA) functional class was 2.94 and 74% of the patients were in sinus rhythm. Multiple valve procedures were required in 39.4% of the cases and 718 valves (64.6%) were repaired. The overall hospital mortality was 4.48%. The mortality for isolated mitral valve repair was 1.8% against 3.48% for replacement. For isolated aortic repair, it was 0 against 8.5% for replacement. The follow-up of our patients was 98.1%. During the follow-up period of 1,171.06 patient years, the total incidence of thromboembolic events was 2.35% or 1.53% pt-yrs. Reoperation was required in 7.3% of the patients. The main cause was dysfunction of the rheumatic mitral repairs in the young patients. The late mortality was 3.78%. The actuarial survival for the total 802 operated patients was 86.27%. This survival was 91.10% for those undergoing repair versus 82.10% for those with replacement (P<0.005). It is concluded that a careful and complete follow-up of our patients is essential to determine the value of the available surgical techniques. The young rheumatic patient, so prevalent in our population, remains a surgical challenge. New surgical alternatives are needed. Ann Saudi Med 1993;13(6):501-507.

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