HEART-VALVE SURGERY IN A YOUNG PREDOMINANTLY RHEUMATIC POPULATION

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%, dege nerative in and 8.7%, infective in 5.9% and ischemic in 2%. The mean p reoperative New York Heart Association (NYHA) functional class was 2.9 4 and 74% of the patients were in sinus rhythm. Multiple valve procedu res were required in 39.4% of the cases and 718 valves (64.6%) were re paired. The overall hospital mortality was 4.48%. The mortality for is olated mitral valve repair was 1.8% against 3.48% for replacement. For isolated aortic repair, it was 0 against 8.5% for replacement. The fo llow-up of our patients was 98.1%. During the follow-up period of 1,17 1.06 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 th e 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 replaceme nt (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 sur gical techniques. The young rheumatic patient, so prevalent in our pop ulation, remains a surgical challenge. New surgical alternatives are n eeded.