Fatores de risco hospitalar para pacientes submetidos à substituição valvar com a bioprótese porcina em instituição universitária / Risk factors for hospital mortality in valve replacement with porcine bioprosthesis at an universitary institution

OBJETIVO: Identificar fatores de risco hospitalar em pacientes submetidos ao implante de bioprótese porcina no Instituto de Cardiologia do Rio Grande do Sul. MÉTODOS: Estudo retrospectivo, com informações de prontuário, de 808 pacientes submetidos ao implante de pelo menos uma bioprótese porcina St. Jude Medical Biocor, no período entre 1994 e 2009. Foi analisada a relação entre mortalidade hospitalar e características clínicas e demográficas definidas em estudos reconhecidos, visando identificar fatores de risco. Foram utilizados testes qui-quadrado, t de Student e regressão logística uni e multivariável (P<0,05). RESULTADOS: Ocorreram 80 (9,9%) óbitos hospitalares. Fatores de risco identificados na regressão logística univariável foram: plastia tricúspide (odds ratio 6,11); lesão mitral (OR 3,98); fração de ejeção de ventrículo esquerdo < 30% (OR 3,82); diabete melito (OR 2,55); fibrilação atrial (OR 2,32); hipertensão pulmonar (OR 2,30); creatinina > 1,4 mg/dL (OR 2,28); cirurgia cardíaca prévia (OR 2,17); hipertensão arterial sistêmica (OR 1,93); classe funcional III e IV (OR 1,92); revascularização miocárdica (OR 1,81); idade > 70 anos (OR 1,80); insuficiência cardíaca congestiva (OR 1,73); e sexo feminino (OR 1,68). Pela regressão logística multivariável, para fatores independentes, identificados: lesão mitral (OR 5,29); plastia tricúspide (OR 3,07); diabete melito (OR 2,72); idade > 70 anos (OR 2,62); revascularização miocárdica (OR 2,43); cirurgia cardíaca prévia (OR 1,82); e hipertensão arterial sistêmica (OR 1,79). CONCLUSÕES: A mortalidade observada nesta casuística é compatível com literatura. Fatores de risco preponderantes são reconhecidos e devem motivar programas específicos de neutralização.

OBJECTIVE: Study designed to identify characteristics of patients related to increased hospital mortality after valve replacement, assumed as risk factors. METHODS: Retrospective study including 808 patients submitted to the implant of St. Jude Biocor porcine bioprosthesis between 1994 and 2009 at Instituto de Cardiologia do Rio Grande do Sul. Primary outcome was hospital death and hospital mortality was related to demographic and surgical characteristics. Statistics include t-test, qui-square test and logistical regression analysis. RESULTS: There were 80 (9.9%) hospital deaths. Risk factors identified with univariable logistical analysis (and respective odds-ratio) were: tricuspid surgery (OR 6.11); mitral valve replacement (OR 3.98); left ventricular ejection fraction < 30% (OR 3.82); diabetes mellitus (OR 2.55); atrial fibrillation (OR 2.32); pulmonary arterial hypertension (OR 2.30); serum creatinine > 1,4 mg/dL (OR 2.28); previous cardiac surgery (OR 2.17); systemic arterial hypertension (OR 1.93); functional class III e IV (OR 1.92); coronary bypass (OR 1.81); age > 70 years-old (OR 1.80); congestive heart failure (OR 1.73); e female gender (OR 1.68). Multivariable logistic regression for independent factors identified preponderant risk factors mitral valve replacement (OR 5,29); tricuspid surgery (OR 3.07); diabetes mellitus (OR 2.72); age > 70 years-old (OR 2.62); coronary bypass (OR 2.43); previous cardiac surgery (OR 1.82); e systemic arterial hypertension (OR 1.79). CONCLUSIONS: Mortality rate is within values found in literature. Identification of risk factors could contribute to changes in surgical indication and medical management in order to reduce hospital mortality.

Risk factors for hospital mortality in valve replacement with porcine bioprosthesis at an universitary institution.

OBJECTIVE: Study designed to identify characteristics of patients related to increased hospital mortality after valve replacement, assumed as risk factors. METHODS: Retrospective study including 808 patients submitted to the implant of St. Jude Biocor porcine bioprosthesis between 1994 and 2009 at Instituto de Cardiologia do Rio Grande do Sul. Primary outcome was hospital death and hospital mortality was related to demographic and surgical characteristics. Statistics include t-test, qui-square test and logistical regression analysis. RESULTS: There were 80 (9.9%) hospital deaths. Risk factors identified with univariable logistical analysis (and respective odds-ratio) were: tricuspid surgery (OR 6.11); mitral valve replacement (OR 3.98); left ventricular ejection fraction < 30% (OR 3.82); diabetes mellitus (OR 2.55); atrial fibrillation (OR 2.32); pulmonary arterial hypertension (OR 2.30); serum creatinine > 1,4 mg/dL (OR 2.28); previous cardiac surgery (OR 2.17); systemic arterial hypertension (OR 1.93); functional class III e IV (OR 1.92); coronary bypass (OR 1.81); age > 70 years-old (OR 1.80); congestive heart failure (OR 1.73); e female gender (OR 1.68). Multivariable logistic regression for independent factors identified preponderant risk factors mitral valve replacement (OR 5,29); tricuspid surgery (OR 3.07); diabetes mellitus (OR 2.72); age > 70 years-old (OR 2.62); coronary bypass (OR 2.43); previous cardiac surgery (OR 1.82); e systemic arterial hypertension (OR 1.79). CONCLUSIONS: Mortality rate is within values found in literature. Identification of risk factors could contribute to changes in surgical indication and medical management in order to reduce hospital mortality.