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

Regina Maria De Aquino Xavier,Vitor Manuel Pereira Azevedo,Arn Migowski,Nelson Albuquerque Souza E Silva,Lucas De Aquino Hashimoto,Marcelo Goulart Correia,Paulo Henrique Godoy,Clara Weksler,Carolina De Aquino Xavier,Rogério Brant Martins Chaves,Antonio Luiz Pinho Ribeiro

doi:10.1186/s12872-017-0725-9

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.

Highlights

Heart valve surgery outcomes are unknown in middle-income countries and cannot be used in health system decision making processes
In Brazil, the incidence of acute rheumatic fever has been reduced in recent decades [8], a large number of patients need to perform heart valve surgery (HVS) to repair or replace valves that have suffered rheumatic injury
This study aims to estimate in-hospital mortality, long-term survival and average length of hospital stay of patients submitted to HVS between 2001 and 2007, from data in the nationwide database of the Brazilian National Health System (Sistema Único de Saúde, SUS)

Summary

Introduction

Heart valve surgery outcomes are unknown in middle-income countries and cannot be used in health system decision making processes. Incidence of acute rheumatic fever has been declining over recent decades in some of these countries, RHD is still considered a major public health problem worldwide [5]. In Brazil, the incidence of acute rheumatic fever has been reduced in recent decades [8], a large number of patients need to perform heart valve surgery (HVS) to repair or replace valves that have suffered rheumatic injury. In these cases, the mitral or aortic valves, or both simultaneously, are the most affected [9]. Brazil has a double burden of diseases connected with poverty, such as rheumatic fever, and degenerative diseases associated with an aging population [10]

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