Differences in mortality between emergency and elective valve exchange surgeries in a tertiary hospital between 2010 and 2021

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): Public institutions. Introduction The natural history of valvular heart disease is very heterogeneous and varies according to the etiology and valve affected. It is well established that the presence of symptoms or some alarm signs indicates interventions to improve the patient’s prognosis. In some cases, the patient is subjected to at a late time of the natural history of his disease, sometimes during clinical instability and this can get a much worse prognosis. Therefore, follow-up of the valvopathic patient is essential to indicate the best moment of intervention. The aim of this study was to analyze the difference in mortality in patients submitted to valve replacement in an elective and in a tertiary hospital. Objectives The aim of this study was to evaluate the risk of morbidity and mortality when comparators the use of biological and metallic prostheses in elective surgeries and emergencies. Methods Medical records were reviewed of patients undergoing valve replacement surgery in an aortic and mitral position in an emergency and elective character between 2010 and 2021. Results A total of 5,340 valve replacement surgeries were performed in an aortic and mitral position, of which 945 were emergency surgical and 4395 in an elective scenario. Among the emergency procedures, there were a total of 270 deaths (28.57%). While in elective procedures mortality was 535 deaths (12.17%). Regarding the nature of the prosthesis, 91.57% were placed biological, where 874 (17.87%) of these procedures were emergency and of these, 255 deaths (29.17%) were recorded. In elective nature, 4,016 prostheses (82.12%) were, among these cases, 499 deaths (12.42%). In relation to mechanical prostheses, the total was 8.42%, 71 of which were placed as an emergency with 15 deaths (21.12%). Valve surgery with mechanical prosthesis was performed in 379 patients and 36 deaths were recorded (9.49%). Conclusion Valve replacement in an emergency context has mortality 2.34 times higher than when performed electively. This data reflects that the intervention at a late stage of the natural history of valvopathies, especially in situations of clinical instability brings the patient a worse prognosis and this shows us the importance of accompanying the valvopathic patient appropriately in an outpatient context to indicate the most opportune moment of valve replacement if the procedure is necessary.