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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Cardiovascular Disorders 1/2017

Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study

BMC Cardiovascular Disorders > Ausgabe 1/2017
Regina Maria de Aquino Xavier, Vitor Manuel Pereira Azevedo, Paulo Henrique Godoy, Arn Migowski, Antonio Luiz Pinho Ribeiro, Rogério Brant Martins Chaves, Marcelo Goulart Correia, Carolina de Aquino Xavier, Lucas de Aquino Hashimoto, Clara Weksler, Nelson Albuquerque Souza e Silva



Heart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival.


This was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002–7.707).


Valve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001).


Rheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.
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