Predictors of in-hospital mortality following mitral or double valve replacement for rheumatic heart disease
Journal Title: Nepalese Heart Journal - Year 2016, Vol 3, Issue 2
Abstract
Backgrounds and Aims: Factors affecting outcome of mitral valve replacement in rheumatic population of Nepal is unknown. The aim of this study was to identify the predictors of in-hospital mortality in patients undergoing mitral or double valve replacement in Nepal. Methods: A retrospective observational study was designed to evaluate the outcome of patients who underwent mitral valve replacement with or without concomitant other valvular surgery during a period of one year in a tertiary care cardiac centre in Nepal. Data were analysed to fnd the signifcant predictors of in-hospital mortality. Results: A total of 411 patients fulflled the inclusion criteria. The overall in-hospital mortality was 4.1% (95% CI 2.18-6.02). A cutoff value for higher mortality obtained using ROC curve for age was 37.5 years; and for duration of mechanical ventilation was 8.5 hours. Multivariate logistic regression model identifed increasing age (>37.5 years), OR 2.05 (95% CI 0.77-5.45), p=0.001; NYHA Class III and IV, OR 15.18 (95%CI 0.9-54.53), p<0.001; presence of left atrial thrombus, OR 4.96 (95% CI 1.49-16.43), p=0.003; tricuspid regurgitation grade III and IV, OR 2.62 (95% CI 0.95-7.24), p=0.004; re-exploration for bleeding, OR 8.62 (95% CI 1.60-46.32), p=0.03; left ventricular ejection fraction (≤40%), OR 8.22 (95% CI 2.62-25.72), p=0.001; inotrope score >20, OR 9.90 (95% CI 3.48-28.15), p<0.001; duration of mechanical ventilation >8.5 hours, OR 22.96 (95% CI 5.15-52.10), p<0.001; and stay in the intensive care unit > 2 days, OR 1.31 (95% CI 0.49-3.46), p<0.001 as predictors of mortality. Conclusion: Age, NYHA Class, severe tricuspid regurgitation, presence of left atrial clot, re-exploration for bleeding, decreasing left ventricular ejection fraction, high inotrope score, longer duration of mechanical ventilation, and longer stay in the intensive care unit were identifed as the independent predictors of in-hospital mortality.
Authors and Affiliations
Apurba Sharma| Departments of Cardiac Anesthesia, Shahid Gangalal National Heart Center, Bansbari, Nepal, Nirmal Panthee| Department of Cardiovascular Surgery Shahid Gangalal National Heart Center, Bansbari, Nepal Corresponding Author Apurba Sharma, Department of Cardiac Anesthesia, Shahid Gangalal National Heart Center Bansbari, Kathmandu, Nepal, Smriti Mahaju Bajracharya| Departments of Cardiac Anesthesia, Shahid Gangalal National Heart Center, Bansbari, Nepal, Bijoy Gopal Rajbanshi| Department of Cardiovascular Surgery Shahid Gangalal National Heart Center, Bansbari, Nepal Corresponding Author Apurba Sharma, Department of Cardiac Anesthesia, Shahid Gangalal National Heart Center Bansbari, Kathmandu, Nepal, Raamesh Raj Koirala| Department of Cardiovascular Surgery Shahid Gangalal National Heart Center, Bansbari, Nepal Corresponding Author Apurba Sharma, Department of Cardiac Anesthesia, Shahid Gangalal National Heart Center Bansbari, Kathmandu, Nepal, Jyotindra Sharma| Department of Cardiovascular Surgery Shahid Gangalal National Heart Center, Bansbari, Nepal Corresponding Author Apurba Sharma, Department of Cardiac Anesthesia, Shahid Gangalal National Heart Center Bansbari, Kathmandu, Nepal, Jeju Nath Pokharel| Departments of Cardiac Anesthesia, Shahid Gangalal National Heart Center, Bansbari, Nepal
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