Predictors of short-term mortality after rheumatic heart valve surgery: A single-center retrospective study

Khalid S Ibrahim; Khalid A Kheirallah; Fadia A Mayyas; Nizar R Alwaqfi; Murtada H Alawami; Qusai M Aljarrah

doi:10.1016/j.amsu.2021.01.077

Predictors of short-term mortality after rheumatic heart valve surgery: A single-center retrospective study

Ann Med Surg (Lond). 2021 Jan 26:62:395-401. doi: 10.1016/j.amsu.2021.01.077. eCollection 2021 Feb.

Authors

Khalid S Ibrahim¹, Khalid A Kheirallah², Fadia A Mayyas³, Nizar R Alwaqfi¹, Murtada H Alawami⁴, Qusai M Aljarrah⁵

Affiliations

¹ Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology and Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Jordan.
² Department of Public Health and Community Health, College of Medicine, Jordan University of Science and Technology, Jordan.
³ Department of Clinical Pharmacy, College of Pharmacy, Jordan University of Science and Technology, Jordan.
⁴ Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
⁵ Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Jordan.

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.

Keywords: Emergency surgery; Mortality; Predictors; Valve surgery.