ONE YEAR FOLLOW UP OF RHEUMATIC HEART

DISEASE’S PATIENTS WHO UNDERWENT

SURGICAL MITRAL VALVE REPLACEMENT IN
SANGLAH HOSIPITAL BALI

AUTHOR :
NABILA NATASYA
KETUT PUTU YASA
DEPARTMENT OF CARDIOVASCULAR, THORACIC AND ENDOVASCULAR SURGERY, SANGLAH
CENTRAL HOSPITAL- UDAYANA UNIVERSITY, BALI, INDONESIA
 BACKGROUND

There are estimated 15 million cases of RHD worldwide dominated in

developing country

There’re no exact data about RHD prevalence in Indonesia, but its

estimated there’re about 0.3-0.8 cases per 1000 people

Around 28-300 mitral valve replacement perform per year in Indonesia

Sanglah central hospital is the only hospital that can performed surgical
valve replacement around East Indonesian
METHOD

Location of research :
• Sanglah General Hospital. Denpasar. Bali

Time of research :
• September 2017 – December 2017

Sample :
• 89 participants registered from 2012-2017
• Underwent surgical valve replacement at Sanglah General
Hospital
METHOD

Research method :
• Single center cohort study, with follow up for 1 year
• Bivariate analysis measure using chi-square
• Multivariate analysis and survival measure using cox-regression
Data collection :
• Secondary data ; Medical record
• Demographic data
• Echocardiography pre operative
• Echocardiography post operative
• Surgical Detail (total time, ACC time, CPB time, and type of
prosthetic valve that we used)
RESULT

73 patients (82%) survive within a year

16 patients (18%) died within a year

9 died counted as hospital mortality

(die <30 day after surgery)
 RESULT

There’s an
Variables Meanimprovement
Mean in
p left heart 95%
function Pre
a year afterPost surgery but not
Confidence
statistically significant
Surgery Surgery Interval
LVEF 59.35% 59.62% 0.673 -1.50 0.97
An improvement in right heart function a
year after1.64
TAPSE surgery1.76
statically significant
0.000 -0.18 -0.06
(p=0.000)
 RESULT
Variables F (%) (n=89) P Value RR
Gender
 Male 29 (32.6%) 0.010* 0.56
 Female 60 (67.4%) 1.52
PH Status
PH 58 (65.2%) 0.039* 1.86
Non-PH 31 (34.8%) 0.72
ACC Used
 <2.5 hours 74 (83.1%) 0.001* 1.23
 >2.5 hours 15 (16.9%) 5.20
CPB Used
 < 4 hours 82 (92.1%) 0.002* 5.31
 > 4 hours 7 (7.9%) 11.40
Type of Valve Used
 Mechanical 60 (67.4%) 0.038* 0.98
 Bioprosthesis 29 (32.6%) 2.05
LVEF PostOp
 Normal - 84 (94.4%) 6.32
Midrange 5 (5.6%) 0.000* 11.40
 Reduced
CONCLUSION

In one year, there’re 82% patients who underwent

mitral valve replacement survive

There are correlation between female gender,

pulmonary hypertension, pre-op LVEF, biophrosthesis
valve, and time in using ACC and CPB with survival
within a year after surgery

The findings from this study can be used to predict

prognosis of RHD patients that will be going to MVR.
Better patients selection and improving surgical
tecnique will give benefit to survival