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

Abstract

BackgroundHeart 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.MethodsThis 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).ResultsValve 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).ConclusionsRheumatic 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.

Estatística Cardiovascular – Brasil 2020

“…193 Esse resultado é semelhante aos de um estudo com 78.808 pacientes usando 2 grandes bases de dados nacionais (o Sistema Brasileiro de Informações Hospitalares e o Sistema Brasileiro de Informações sobre Mortalidade) de 2001 a 2007, em que apenas 0,24% (187) dos casos informavam prolapso mitral como causa básica. 206 Entretanto, os dados podem apresentar viés em razão da ausência de atribuição de código para as etiologias de doença valvar cardíaca no sistema público de saúde e na maior parte do sistema privado de saúde. • Entretanto, a incidência crescente de doença valvar aórtica calcífica também em indivíduos com idade de 15-49 anos, 23,4% (II 95%, 18,1 -28,7), é atípica considerando-se a epidemiologia da doença, devendo ser interpretada com cautela como uma possível limitação da modelagem GBD, 200 pois dados primários para essa causa são escassos no Brasil.…”

“…19 No cenário mais desassistido, a DCR tem desempenhado importante papel por décadas, com tendência decrescente -nem sempre adequadamente capturada pela modelagem estatísticaseguindo melhoria socioeconômica. 189,194,206 Doença Cardíaca Reumática , apesar do crescimento da população (Tabela 5-3). Essas tendências podem refletir uma melhoria nas condições de saúde, além de melhor e mais precoce acesso à assistência em saúde.…”

Valve Heart Surgery in Brazil – The BYPASS Registry Analysis

“…Vasoplegic syndrome, (n) % 3 (1%) 0 (0%) 0 (0%) 1 (2%) 3 (4.1%) 0 (0%) 2 (7.1%) 0 (0%) 0 (0%) 9 (1%) [8] .…”

Rheumatic heart disease: The role of global cardiac surgery

“…39 In Latin America, similar trends are observed, although with variable outcomes. 40 Notable local experiences are described as follows: Yangni-Angate et al 41 In their experience, late presentation in the younger patients with advanced RHD precludes valve repair. In addition, bioprosthetic valve replacement developed early deterioration.…”