Background In middle income countries, the burden of rheumatic heart disease (RHD) remains high, but the prevalence of other heart valve diseases may rise as the population life expectancy increases. Here, we compared population-based data on surgical procedures to assess the relative importance of causes of heart valve disease in Salvador, Brazil. Methodology/Principal Findings Medical charts of patients who underwent surgery for valvular heart disease from January 2002–December 2005 were reviewed. Incidence of surgery for valvular heart disease was calculated. Logistic regression was used to identify factors associated with in-hospital death following surgery. The most common etiologies for valvular dysfunction in 491 valvular heart surgery patients were RHD (60.3%), degenerative valve disease (15.3%), and endocarditis (4.5%). Mean annual incidence for surgeries due to any valvular heart diseases, RHD, and degenerative valvular disease were 5.02, 3.03, and 0.77 per 100,000 population, respectively. Incidence of surgery due to RHD was highest in young adults; procedures were predominantly paid by the public health sector. In contrast, the incidence of surgery due to degenerative valvular disease was highest among those older than 60 years of age; procedures were mostly paid by the private sector. The overall in-hospital case-fatality ratio was 11.9%. Independent factors associated with death included increase in age (odds ratio: 1.04 per year of age; 95% confidence interval: 1.02–1.06), endocarditis (6.35; 1.92–21.04), multiple valve operative procedures (4.35; 2.12–8.95), and prior heart valve surgery (2.49; 1.05–5.87). Conclusions/Significance RHD remains the main cause for valvular heart surgery in Salvador, which primarily affects young adults without private health insurance. In contrast, surgery due to degenerative valvular disease primarily impacts the elderly with private health insurance. Strategies to reduce the burden of valvular heart disease will need to address the disparate factors that contribute to RHD as well as degenerative valve disease.
References
[1]
Ray S (2010) History of valvular heart disease. Clin Med 10: 168–171.
[2]
Boudolas H, Vavuranakis M, Wooley C (1994) Valvular Heart Disease: The influence of changing etiology on nosology. J Heart Valve Dis 3: 516–526.
[3]
Rose AG (1996) Etiology of Valvular Heart Disease. Curr Opin Cardiol 11: 98–113.
[4]
Soler-Soler J, Galve E (2000) Worldwide perspective of valve disease. Heart 83: 721–725.
[5]
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, et al. (2006) Burden of valvular heart diseases: A population-based study. Lancet 368: 1005–1011.
[6]
Iung B, Vahanian A (2011) Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol 8: 162–172.
[7]
Carapetis JR, Steer AC, Mulholland EK, Weber M (2005) The global burden of group A streptococcal diseases. Lancet Infect Dis 5: 685–694.
[8]
Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, et al. (2007) Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 357: 470–476.
[9]
Kleinert S, Horton R (2011) Brazil: Towards sustainability and equity in health. Lancet 377: 1721–1722.
[10]
Instituto Brasileiro de Geografia e Estatística (2008) Proje？？o da popula？？o do Brasil por sexo e idade 1980–2050, Revis？o 2008. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística. 96 p. 20: Available: http://www.ibge.gov.br/home/estatistica/？populacao/projecao_da_populacao/2008/pro？jecao.pdf. Acessed 2012 January.
[11]
Lisboa LAF, Moreira LFP, Mejia OV, Dallan LAO, Pomerantzeff PMA, et al. (2010) [Evolution of cardiovascular surgery at the Instituto do Cora？？o: analysis of 71,305 surgeries]. Arq Bras Cardiol 94: 162–168.
[12]
Datasus , Departamento de Informática do SUS, Secretaria Executiva, Ministério da Saúde (2012) Popula？？o residente por ano segundo faixa etária detalhada, Salvador, 2002–2005. 09: Available: http://tabnet.datasus.gov.br/cgi/tabcgi.？exe?ibge/cnv/popba.def. Acessed 2012 Apr.
[13]
Enriquez-Sarano M, Akins CW, Vahanian A (2009) Mitral regurgitation. Lancet 373: 1382–1394.
[14]
Monin J-L, Dehant P, Roiron C, Monchi M, Tabet J-Y, et al. (2005) Functional assessment of mitral regurgitation by transthoracic echocardiography using standardized imaging planes diagnostic accuracy and outcome implications. J Am Coll Cardiol 46: 302–9.
[15]
Enriquez-Sarano M, Freeman WK, Tribouilloy CM, Orszulak TA, Khandheria BK, et al. (1999) Functional anatomy of mitral regurgitation: Accuracy and outcome implications of transesophageal echocardiography. J Am Coll Cardiol 34: 1129–1136.
[16]
Olson LJ, Subramanian R, Ackermann DM, Orszulak TA, Edwards WD (1987) Surgical pathology of the mitral valve: A study of 712 cases spanning 21 years. Mayo Clin Proc 62: 22–34.
[17]
Edwards FH, Peterson ED, Coombs LP, DeLong ER, Jamieson WRE, et al. (2001) Prediction of operative mortality after valve replacement surgery. J Am Coll Cardiol 37: 885–892.
[18]
Nowicki ER, Birkmeyer NJO, Weintraub RW, Leavitt BJ, Sanders JH, et al. (2004) Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg 77: 1966–1977.
[19]
Jamieson WR, Edwards FH, Schwartz M, Bero JW, Clark RE, et al. (1999) Risk stratification for cardiac valve replacement. National Cardiac Surgery Database. Ann Thorac Surg 67: 943–951.
[20]
WHO Expert Consultation on rheumatic fever, rheumatic heart disease (2004) Rheumatic fever and rheumatic heart disease: Report of a WHO Expert Consultation, Geneva, 29 October –1 November 2001. Geneva: World Health Organization. 130 p.
