Mortality Impact of Thoracic Aortic Disease in São Paulo State from 1998 to 2007

Abstract

BackgroundThe epidemiological characteristics of thoracic aortic diseases (TAD) in the State of São Paulo and in Brazil, as well as their impact on the survival of these patients have yet to be analyzed.ObjectivesTo evaluate the mortality impact of TAD and characterize it epidemiologically.MethodsRetrospective analysis of data from the public health system for the TAD registry codes of hospitalizations, procedures and deaths, from the International Code of Diseases (ICD-10), registered at the Ministry of Health of São Paulo State from January 1998 to December 2007.ResultsThey were 9.465 TAD deaths, 5.500 men (58.1%) and 3.965 women (41.9%); 6.721 dissections (71%) and 2.744. aneurysms. In 86.3% of cases the diagnosis was attained during autopsy. There were 6.109 hospitalizations, of which 67.9% were males; 21.2% of them died (69% men), with similar proportions of dissection and aneurysm between sexes, respectively 54% and 46%, but with different mortality. Men with TAD die more often than women (OR = 1.5). The age distribution for deaths and hospitalizations was similar with predominance in the 6th decade. They were 3.572 surgeries (58% of hospitalizations) with 20.3% mortality (patients kept in clinical treatment showed 22.6% mortality; p = 0.047). The number of hospitalizations, surgeries, deaths of in-patients and general deaths by TAD were progressively greater than the increase in population over time.ConclusionsSpecific actions for the early identification of these patients, as well as the viability of their care should be implemented to reduce the apparent progressive mortality from TAD seen among our population.

Does aortic valve repair in valve-sparing aortic root reconstruction compromise the longevity of the procedure?

“…However, these authors also found that there is a lack of information regarding the incidence and prevalence of TAD disease, whose mortality rate is high. Moreover, they noticed that patients with TAD are extremely difficult to manage, since local centers are often unable to effectively treat these patients, the referral of affected patients to centers specializing in TAD treatment is inefficient and the results of treatment provided by the centers to which patients are referred are often suboptimal 2 .…”

Surgery of the aortic root: Should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

“…In our midst, we still have little knowledge on the impact of this disease in the general population. It has been observed that its mortality in the state of São Paulo is still very high due to either the shortcomings and inefficiency of our health system in identifying, screening, and treating these patients or the inadequate results obtained with hospitalized patients receiving drug treatment or even those who had undergone a surgical procedure (despite results being substantially better when these patients underwent surgery) [ 7 ] .…”

“…A first step has been taken. In the state of São Paulo, even though a significant increase has been observed in the number of diagnostics, hospitalizations, and procedures during the period of the study [ 7 ] , there is a lot to be done in order to improve the results of these interventions.…”

Tratamento Farmacológico E Interações Medicamentosas Em Pacientes Com Aneurisma Da Aorta Abdominal

“…Os dados da literatura determinam diferentes valores na prevalência do AAA devido às características clínicas de cada amostra e região. No Brasil um estudo retrospectivo feito de 1998 a 2007 com dados do registro de internações e procedimentos do Sistema Único de Saúde, revelou que o AAA e os aneurismas ocupam a 30º causa mais frequente de óbito na população do Estado de São Paulo, sendo 3.539 óbitos de homens devido à dissecação da aorta e 1.383 óbitos referentes à ruptura do AAA (3). A prevalência do AAA é 4% a 8% em homens e em mulheres 0,5% -1,5%, variando de acordo com raça, idade, história familiar, localização geográfica e consumo de cigarro (4).…”

“…Os fatores de risco mais frequentes associados à AAA neste estudo foram: gênero masculino, tabagismo, antecedente de AAA e portadores de doença arterial oclusiva periférica, insuficiência coronariana e doença pulmonar obstrutiva crônica (5). Nos Estados Unidos da América (EUA), a doença é 13ª causa de óbitos sendo responsável por 30.000 óbitos por ano, principalmente em indivíduos com mais de 60 anos (1)(2)(3)(4)(5)(6).…”