Retrospective analysis shows mortality rates and risk factors after prosthetic heart valve surgeries

Background and objectives

Mechanical valve replacement is a primary treatment for rheumatic heart disease, yet prosthesis-related adverse outcomes remain underreported in India. This study aimed to examine the in-hospital mortality rate among patients who underwent prosthetic heart valve replacement surgeries in the past five years.

Methods

A retrospective analysis of 221 rheumatic heart disease patients (2019–2023) who underwent aortic valve replacement (AVR), mitral valve replacement (MVR), or double valve replacement (DVR) was conducted. Comorbidities (hypertension, type-2 diabetes mellitus) and valve origin (Indian vs. foreign-made) were also evaluated. Data were analyzed using SPSS (v25.0), with p < 0.05 considered statistically significant.

Results

Among 221 patients, 262 valves were implanted (54 AVR, 126 MVR, 41 DVR). Overall in-hospital mortality was 7.24% (16/221), with rates of 5.55% (AVR), 7.14% (MVR), and 9.75% (DVR). No sex-based differences were observed (p > 0.05). The five-year actuarial survival rate was 92.8±4.8%, with no intergroup disparities (p > 0.05). Mortality was higher in patients >50 years (13/16 deaths) and in females (10/16 deaths), though these differences were not statistically significant. Hypertension was more prevalent in females and type-2 diabetes mellitus in males, but neither condition showed a significant association with outcomes (p > 0.05). Most fatalities were associated with thromboembolism, acute kidney injury, and congestive heart failure, and valve origin did not significantly impact mortality.

Conclusions

At our tertiary care center, we observed a 7.24% mortality rate over the past five years following prosthetic heart valve implantation across all age groups. While trends indicated potentially higher mortality rates among female and elderly patients, these differences were not statistically significant. The in-hospital mortality rate of 7.24% is consistent with studies conducted in India but exceeds those reported in Western data. This elevated mortality in Indian patients could be attributed to delayed surgeries, which often result in established right heart failure and organ dysfunction. Furthermore, improving long-term outcomes, such as reducing thromboembolism, in patients with mechanical valves presents a continuing challenge. To improve long-term patient outcomes, it is crucial to gather comprehensive data on delayed valve-related complications and mortality. Although this study is limited by its small sample size and single-arm design, its findings can provide valuable insights for designing similar single-center, single-arm, long-term retrospective studies.