Abstract 19733: Long Term Outcomes of 78,808 Patients Undergoing Valve Heart Surgery in a Middle-income Country

Abstract

Background: The outcomes of heart valve surgery (HVS) are unknown in middle-income countries. Objectives: To analyze in-hospital and survival of HVS from 2001 to 2007 in Brazil. Methods: This is a retrospective observational study of 78,806 patients. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier and log-rank tests were performed. The outcome measures were in-hospital mortality and all-cause mortality during follow-up. These measures have been obtained by probabilistic record linkage of the databases. Results: The maximum and median follow-up was 7.7 and 2.8 years. Sex distribution was similar. Median age was 50.0 (35.9 - 62.5). Valve replacement (VRp) accounted for 69.1%. The most common valve injury was mitral stenosis with 38.9%, and was rheumatic heart disease (RHD) in 94.7%. The median age in RHD was lower (44.2) than in the remaining cohort (57.5) (p<0.001). In-hospital mortality was 7.6%. It was higher for females (7.8% versus 7.3% - p<0.001), for concomitant CABG patients (14.6%; p<0.001), and for the elderly (18.42%; p<0.001). Overall survival was 69.9% at the end of the follow-up time. Survival by sex at the year 1 and 5 were respectively, for female 85.0% and 76.5%, for male 84.2% and 72.5%. At the end of the first and fifth year of follow-up time, the survival rates of the age ≥80 group and 20 and 39 years group were respectively 64.7%, and 46.4%, against 91.5% and 85.1%. Survival for concomitant CABG at year 1 and year 5 of follow up were 72.1% and 58.1% and for those who underwent solely HVS, 85.9% and 76.0%, respectively. Concomitant CABG showed increased risk (HR 1.3123, CI95%1.2271 - 1.4033, p<0.0001), and age contributed as secondary increasing factor (HR 1.0216, CI95% 1.0203 - 1.0229, p<0.0001). In non-concomitant CABG, patients submitted to valve repair compared with VRp or multiple surgeries showed a reduced risk (HR 0.6937, CI95%0.6296 - 0.7645, p<0.0001), but age contributed as secondary increasing factor in this set (HR 1.0209, CI95%1.0195 - 1.0222, p<0.0001). Conclusions: The magnitude of RHD in Brazil is still great. In-hospital mortality and survival of HVS were less satisfactory compared to those reported in high-income countries.