Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease

Abstract

Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results.Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease.Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant.Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion:The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.

Morbidity and Mortality in Patients Undergoing Mitral Valve Replacement at a Cardiovascular Surgery Referral Service: a Retrospective Analysis

“…A study by Khan et al [ 22 ] failed to establish relationship between the type of injury and higher mortality. Likewise, it is not yet well established which associated valve lesions imply the highest surgical risk, although tricuspid regurgitation has already been identified as an independent risk factor for death and morbidity [ 12 , 23 ] .…”

Estatística Cardiovascular – Brasil 2021

“…Portanto, o reparo da valva mitral permanece sendo uma estratégia razoável para DCR em idades mais jovens. 218 …”

Women Undergoing Mitral Valve Replacement: A Retrospective Analysis

“…Thus, probably, the choice of the type of prosthesis was based not only on technical but also on socioeconomic issues, and the decision was made by the medical staff and the patient. Kim et al 16 and Cruz et al 36 have demonstrated severe tricuspid regurgitation as a risk factor, and Rankin et al 22 and De Bacco et al, 32 respectively, have identified a history of previous valve surgery, and urgency of surgery as risk factors. Elevated cardiopulmonary bypass and aortic clamping times have already been described by Bueno et al 29 However, we could not demonstrate such associations, which is in accordance with results reported in other studies.…”