Single-centre retrospective cohort analysis of aortic valve replacements in under 20 year-olds

Abstract

Background: Rheumatic heart disease (RHD) affects 8.6 in 1000 indigenous children, yet is almost non-existent in non-indigenous children of the same age group. Australia is one of the few developed nations where RHD remains a significant public health challenge. RHD most commonly affects the mitral valve although the aortic valve is also uncommonly affected and surgery remains the corner stone of treatment for RHD. Methods: We have investigated into long term outcomes of aortic valve replacement (AVR) in patients under 20 years old at time of operation. We aim to answer to questions of whether there is large discrepancy in Indigenous Australian population and determine mortality and morbidities and underlying factors that influence the differences. Results: Total of 50 children under the age of 20 years old underwent aortic valve replacement operation between January 2010 and December 2022. Average age of this population was 13.2 years old and 36 males (72%). 10 (20%) patients underwent bioprosthetic AVR and 2 (4%) patients underwent homograft AVR with others (76%; 38/50) undergoing mechanical AVR. Total of 4 deaths occurred within this population with 1 death occurring in indigenous Australian (1/5; 20%) and 3 in non-indigenous population (3/45; 6.7%; p=0.307). Redo-operation for aortic valve replacement occurred in 2 children (2/50; 4%) within the follow up period with two other children undergoing aortic dissection repair and left ventricular aneurysm repair, all of which occurred in non indigenous Australian group. Conclusion: Aboriginal population have statistically non-proportionate number of presentation to general public but a higher rate of mortality presented int he paediatric population. It is an ongoing issue to address this discrepancy and provided best directed surgical care possible.