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Chronic disease
SP1-100 Survival analysis and risk factors for valve surgery in Brazilian children and adolescents with rheumatic heart disease
  1. R E Müller1,2,
  2. M V M Peixoto2,
  3. L Higa2,
  4. M Cunha3,
  5. R Xavier1,
  6. M C Kuschnir1,4
  1. 1National Cardiology Institute (INC), Rio de Janeiro, Brazil
  2. 2Fernandes Figueira Institute (IFF)/FIOCRUZ, Rio de Janeiro, Brazil
  3. 3National Public Health School, FIOCRUZ, Rio de Janeiro, Brazil
  4. 4State University of Rio de Janeiro, Rio de Janeiro, Brazil

Abstract

Introduction Rheumatic heart disease (RHD) is still prevalent in developing countries, with 332.000 annual deaths estimated worldwide. In Brazil, RHD remains a major problem, responsible for high mortality/morbidity and great social impact, with many patients requiring surgical intervention during childhood. Our aim was to investigate the time and risk factors leading to valve surgery in children and adolescents with RHD in a tertiary center in Rio de Janeiro.

Methods Data were reviewed on 137 patients followed-up between 1988 and 2007. RHD diagnosis was assigned with revised Jones criteria and/or Doppler-echocardiography indicating chronic mitral/aortic lesions. Kaplan–Meier method was used to determine time until surgery and Cox model to evaluate potential risk factors: age; gender; clinical status (acute; recurrence; chronic heart disease); recurrence rate; secondary prophylactic status and endocarditis.

Results The studied population was 52.5% female, median age 11.2 years. Median follow-up time 7.3 years. The proportions were 33.5% for non-adherence to prophylaxis, 31.4% for recurrence rate, 8.8% for endocarditis where most underwent surgery (83.3%). Surgical rate (41%) was different between male (53.8%) and female (29.2%). Survival curves showed most events on the first 2 years and none after 10 years. Cox analysis confirmed the male gender and endocarditis as significant factors.

Conclusion Brazilian RHD children and adolescents committed with endocarditis suffered more risk of having valve surgery. Although most patients underwent surgery in first 2 years, long-term surveillance of this population is necessary because of possible reintervention. Survival analysis for repetitive events should be applied to the evaluation of recurrent episodes and reoperation.

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