Poster Presentation 20th Lancefield International Symposium on Streptococci and Streptococcal Diseases 2017

Morbidity and mortality following valve replacement surgery for rheumatic heart disease in Fiji (#219)

Samantha Colquhoun 1 , Reapi L Mataika 2 , Joseph H Kado 3 , Maciu Silai 4 , Maureen Ah Kee 4 , Frances Matanatabu 4 , Nigel J Wilson 5 , William May 6 , Daniel Engelman 1 , Andrew C Steer 1
  1. Murdoch Childrens Research Institute and University of Melbourne, Parkville, VICTORIA, Australia
  2. Paediatrics, Fiji Ministry of Health and Medical Services, Labasa, Fiji
  3. Paediatrics, FIji National University, Suva, Fiji
  4. Wellness Unit, Fiji Ministry of Health and Medical Services, Suva, Fiji
  5. Auckland District Health Board, Auckland, New Zealand
  6. Department of Medicine, Fiji National University, Suva, Fiji

Fiji has one of the highest recorded prevalences of Rheumatic Heart Disease (RHD) in the world. If  RHD is not effectively controlled, many children and young adults identified with early stages of the disease will eventually require cardiac surgery and life-long medical care. No surgical capacity for undertaking open heart surgery including valve replacement is available in the Pacific Islands region; instead Fiji (and other other near by countries) are visited annually by fly-in-fly out cardiac surgical teams who undertake mechanical valve replacement surgery. Anecdotal reports from clinicians in Fiji, and one prior research study, have shown that RHD patients have poor outcomes and much associated morbidity and mortality following valve replacement.

We  reviewed patient medical records of all RHD patients who had cardiac surgery with artificial replacement of heart valves in Fiji during a 5 year period. Patient medical records were examined to identify the treatment, drug therapy, clinical management, complications and outcomes.  123 patients were identified, 109 medical records were located and reviewed. Mortality and complication rates were high; 27% of patients found to be deceased and post-surgical complications, particulary related to thrombosis common. The majority of complications were recorded in the period of 1 month – 1 year post surgery. A survival analysis will be undertaken. These data provide a greater understanding of clinical management issues that can potentially be targeted by the Fiji Ministry of Health RHD control programme to improve patient care and outcomes to reduce the rates of post-surgical RHD complications and mortality.