De Bacco Mateus W, Sant'Anna João Ricardo M, De Bacco Gustavo, Sant'Anna Roberto T, Santos Marisa F, Pereira Edemar, Costa Altamiro Reis da, Prates Paulo Roberto, Kalil Renato A K, Nesralla Ivo A
Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brasil.
Arq Bras Cardiol. 2007 Aug;89(2):113-8, 125-30. doi: 10.1590/s0066-782x2007001400009.
Identification of preoperative heart valve surgery risk factors aim to improve surgical outcomes with the possibility to offset conditions related to increased morbidity and mortality.
Intent of this study is to identify hospital risk factors in patients undergoing bovine pericardial bioprosthesis implantation.
Retrospective study including 703 consecutive patients who underwent implantation of at least one St. Jude Medical-Biocor bovine pericardial bioprosthesis between September 1991 and December 2005 at the Rio Grande do Sul Cardiology Institute; 392 were aortic, 250 were mitral and 61 were mitroaortic. Characteristics analyzed were gender, age, body mass index, NYHA (New York Heart Association) functional class, ejection fraction, valve lesions, systemic hypertension, diabetes mellitus, kidney function, arrhythmias, prior heart surgery, coronary artery bypass graft, tricuspid valve surgery and elective, urgent or emergency surgery. Main outcome was in-hospital mortality. Relationship between risk factors and in-hospital mortality was analyzed using logistic regression.
Were 101 (14.3%) in-hospital deaths. Characteristics with significant relationship to increased mortality were female gender (p<0.001), age over 70 years (p=0.004), atrial fibrillation (p=0.006), diabetes mellitus (p=0.043), creatinine > 2.4 mg/dl (p=0.004), functional class IV (p<0.001), mitral valve lesion (p<0.001), previous heart surgery (p=0.005), tricuspid valve surgery (p<0.001) and emergency surgery (p<0.001).
Mortality rate observed is accepted by literature and is justifiable due to the high prevalence of risk factors, showing an increased significance level for female gender, age above 70, functional class IV, tricuspid valve repairs and emergency surgery. Offsetting these factors could contribute to reduced in-hospital mortality for valve surgery.
术前心脏瓣膜手术风险因素的识别旨在改善手术结果，并有可能抵消与发病率和死亡率增加相关的状况。
本研究的目的是确定接受牛心包生物假体植入患者的医院风险因素。
回顾性研究纳入了1991年9月至2005年12月期间在南里奥格兰德心脏病学研究所连续接受至少一枚圣犹达医疗-生物心牛心包生物假体植入的703例患者；其中392例为主动脉瓣置换，250例为二尖瓣置换，61例为二尖瓣和主动脉瓣置换。分析的特征包括性别、年龄、体重指数、纽约心脏协会（NYHA）心功能分级、射血分数、瓣膜病变、系统性高血压、糖尿病、肾功能、心律失常、既往心脏手术、冠状动脉搭桥术、三尖瓣手术以及择期、紧急或急诊手术。主要结局为住院死亡率。采用逻辑回归分析风险因素与住院死亡率之间的关系。
有101例（14.3%）住院死亡。与死亡率增加有显著关系的特征包括女性（p<0.001）、年龄超过70岁（p=0.004）、心房颤动（p=0.006）、糖尿病（p=0.043）、肌酐>2.4mg/dl（p=0.004）、心功能IV级（p<0.001）、二尖瓣病变（p<0.001）、既往心脏手术（p=0.005）、三尖瓣手术（p<0.001）和急诊手术（p<0.001）。
观察到的死亡率为文献所认可，且由于风险因素的高患病率是合理的，显示女性、70岁以上、心功能IV级、三尖瓣修复和急诊手术的显著性水平增加。抵消这些因素可能有助于降低瓣膜手术的住院死亡率。
