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Influencia del sistema de salud de procedencia y otros factores en el resultado del reemplazo valvular mitral / Influence of the referring health care systems and other factors on the results of mitral valve replacement
Morán, Sergio; Muñoz, Cecilia; Garayar, Bernardita; Zalaquett, Ricardo; Irarrázaval, Manuel J; Becker, Pedro; González, Rodrigo.
  • Morán, Sergio; Pontificia Universidad Católica de Chile. Facultad de Medicina. División de Enfermedades Cardiovasculares. Santiago. CL
  • Muñoz, Cecilia; Pontificia Universidad Católica de Chile. Facultad de Medicina. División de Enfermedades Cardiovasculares. Santiago. CL
  • Garayar, Bernardita; Pontificia Universidad Católica de Chile. Facultad de Medicina. División de Enfermedades Cardiovasculares. Santiago. CL
  • Zalaquett, Ricardo; Pontificia Universidad Católica de Chile. Facultad de Medicina. División de Enfermedades Cardiovasculares. Santiago. CL
  • Irarrázaval, Manuel J; Pontificia Universidad Católica de Chile. Facultad de Medicina. División de Enfermedades Cardiovasculares. Santiago. CL
  • Becker, Pedro; Pontificia Universidad Católica de Chile. Facultad de Medicina. División de Enfermedades Cardiovasculares. Santiago. CL
  • González, Rodrigo; Pontificia Universidad Católica de Chile. Facultad de Medicina. División de Enfermedades Cardiovasculares. Santiago. CL
Rev. méd. Chile ; 141(7): 861-869, jul. 2013. ilus
Article in Spanish | LILACS | ID: lil-695767
ABSTRACT

Background:

There is no consensus regarding which risk factors influence the outcome of mitral valve replacement.

Aim:

To study the effects ofthe referring health care system and other factors on the results of mitral replacement. Patients and

Methods:

We included 632 patients operated between 1990 and 2010 receiving the St Jude prosthesis. Patients were divided into three groups, group 1 composed by 180 patients coming from the Public System, group 2 composed by 182 patients coming from the University System and group 3 composed by 270 patients coming from the Private System.

Results:

Overall operative mortality was 4.3%. There was no difference between groups in mortality. Factors responsible for operative mortality were emergency operation (Odds Patio (OR) 5.6 P < 0.01) and left ventricular function (according to ejection fraction) grade III to IV (OR 2.5 p = 0.048). Actuarial survival rates at 1, 5, 10, 15 and 20 years were 95%, 87%, 76%, 61% and 41%, respectively. Risk factors for long-term mortality were diabetes (OR 3.3 p < 0.01), left ventricular function grades III-IV (OR 2.6 p < 0.01), New York Heart Association functional class III to PV (OR 2.1 p < 0.005) and male sex (OR 1.5 p < 0.032).

Conclusions:

Referring health care system and type of surgery do not constitute a risk factor for mitral replacement. Risk factors were emergency surgery, ventricular function grades III-IV, diabetes, functional capacity class III-IV and male sex. Integration of public and private health care systems in a university hospital setting achieves excellent outcomes for complex pathology.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Hospitals, Private / Hospital Mortality / Heart Valve Prosthesis Implantation / Heart Valve Diseases / Hospitals, Public / Hospitals, University Type of study: Etiology study / Risk factors Limits: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male Language: Spanish Journal: Rev. méd. Chile Journal subject: Medicine Year: 2013 Type: Article Affiliation country: Chile Institution/Affiliation country: Pontificia Universidad Católica de Chile/CL

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Full text: Available Index: LILACS (Americas) Main subject: Hospitals, Private / Hospital Mortality / Heart Valve Prosthesis Implantation / Heart Valve Diseases / Hospitals, Public / Hospitals, University Type of study: Etiology study / Risk factors Limits: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male Language: Spanish Journal: Rev. méd. Chile Journal subject: Medicine Year: 2013 Type: Article Affiliation country: Chile Institution/Affiliation country: Pontificia Universidad Católica de Chile/CL