Ibrahim KS, Kheirallah KA, Mayyas FA, Alwaqfi NR, Alawami MH, Aljarrah QM. Predictors of short-term mortality after rheumatic heart valve surgery: A single-center retrospective study.
Ann Med Surg (Lond) 2021;
62:395-401. [PMID:
33552502 PMCID:
PMC7851328 DOI:
10.1016/j.amsu.2021.01.077]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/11/2022] Open
Abstract
Background
Valve replacement surgeries holds risks of morbidity and mortality.
Materials and methods
The study cohort included 346 patients who underwent different types of valve surgery, excluding redo and Bentall operations. All operations were performed through a median sternotomy using cardiopulmonary bypass.
Results
Mean patient age was 51.6 ± 16.1 years, and 51% were male. Approximately 21% had diabetes, and 44.6% were hypertensive. Aortic valve replacement (AVR) was performed in 125 patients (37%), mitral valve replacement (MVR) in 95 (28%), combined AVR and MVR in 42 (13%), AVR plus coronary artery bypass grafting (CABG) in 19 (6%), and MVR plus CABG in 32 (10%). Operative mortality was 5.8% (n = 20). In the bivariate-level analysis, older age, operation type, hypertension, emergency surgery, use of a biological valve in the aortic or mitral position, pump time greater than 120 min, and aortic clamp time greater than 60 min were significant predictors of 30-day mortality. Use of medications stratified by duration (less than or more than a month) was also shown to be a predictor of mortality. Use of angiotensin-converting enzyme inhibitors, digoxin, beta-blockers, statins, and loop diuretics was associated with mortality. Older age, emergency/salvage surgery, use of beta-blockers for less than 1 month preoperatively, and use of a biological valve in the aortic position were significant and independent predictors of 30-day mortality.
Conclusion
Age, emergency valve surgery, use of a biological valve, use of beta-blockers for less than 1 month before surgery, type of surgery, EF<35%, pump time, and cross clamp time were all found to be independent predictors of mortality in patients undergoing valve surgery. Further prospective multicenter studies may be needed to provide a comprehensive assessment of mortality in patients undergoing valve surgery in Jordan.
Rheumatic heart disease is still a health issue in developing countries.
Developed countries are facing rheumatic patients due to forced immigrations.
Early diagnosis and early referral to surgery is correlated with better outcomes.
More than eight predictors were found to be independent predictors of mortality.
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