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.
Gaziano JM. Global Burden of Cardiovascular Disease. In: Braunwald E, Zipes D, Libby P, editors. Heart Disease. 8th ed. New York: WB Saunders, Elsevier; 2007. p. 1–34.
Boudoulas KD, Borer JS, Boudoulas H. Etiology of valvular heart disease in the 21st century. Cardiology. 2013;126:139–52.
World Health Organ Tech Rep Ser. Rheumatic fever and rheumatic heart disease. 2004;923:1–122
Azevedo VMP, Müller RE, Kaufman R, Santos MA, Chaves RBM, Migowski A, Pinheiro MC, Xavier RMI. Rheumatic fever in Brazilian young adults an already controlled disease? An overview about the last 21 years epidemiological data. Global Heart. 2014;9(1, suppl):e259.
Otto CM, Bonow RO. Valvular heart disease. In: Braunwald E, Zipes D, Libby P, editors. Heart Disease. 8 ed. New York: WB Saunders, Elsevier; 2007. p. 1625–1712.
IBGE. Estimativas da população residente no Brasil e unidades da Federação com data de referência em 1° de julho de 2014. Rio de Janeiro: IBGE. 2014:135.
IBGE. Um panorama da saúde no Brasil: acesso e utilização dos serviços, condições de saúde e fatores de risco e proteção à saúde 2008. Rio de Janeiro: IBGE. 2010:245.
Sistema de Informações Hospitalares do SUS (SIH/SUS) [Internet]. 2015 [cited 04 March 2015]. Available from: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sih/cnv/nruf.def.
Migowski A, Ribeiro AL, Carvalho MS, Azevedo VM, Chaves RB, Hashimoto LA, Xavier CA, Xavier RM. Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings. BMC Cardiovasc Disord. 2015;15:22. CrossRefPubMedPubMedCentral
Kleinbaum DGKM. Survival analysis: a self-learning text. 3rd ed. USA: Springer; 2012. 695 p.
Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on Valvular heart disease. Eur Heart J. 2003;24:1231–43. CrossRefPubMed
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, DK MG, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292. CrossRefPubMed
Kirklin JKKN, Blackstone EH, Hanley FL. Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results and indications. 4th ed. Elsevier Saunders: USA; 2013.
Nicolini F, Agostinelli A, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, Pigini F, De Palma R, Gherli T. Outcomes of patients undergoing concomitant mitral and aortic valve surgery: results from an Italian regional cardiac surgery registry. Interact Cardiovasc Thorac Surg. 2014;19:763–70. CrossRefPubMed
IBGE. Projeção da população do Brasil por sexo e idade 1980-2050, Revisão 2008. Rio de Janeiro: IBGE; 2008.
Saxena A, Dinh D, Smith JA, Reid CM, Shardey GC, Newcomb AE. Excellent short-and long-term outcomes after concomitant aortic valve replacement and coronary artery bypass grafting performed by surgeons in training. The journal of the thoracic and. Cardiovasc Surg. 2013 Feb;145:334–40.
- Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study
Regina Maria de Aquino Xavier
Vitor Manuel Pereira Azevedo
Paulo Henrique Godoy
Antonio Luiz Pinho Ribeiro
Rogério Brant Martins Chaves
Marcelo Goulart Correia
Carolina de Aquino Xavier
Lucas de Aquino Hashimoto
Nelson Albuquerque Souza e Silva
- BioMed Central
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