Table 1
Baseline characteristics by valve disease etiology.
| RHEUMATIC | DEGENERATIVE | CONGENITAL | TOTAL | p-value | |
|---|---|---|---|---|---|
| n | 26261 | 30620 | 2056 | 63426 | |
| Records per Patient | 9.4 ± 34.7 | 11.9 ± 41.6 | 10.1 ± 38.4 | 10.7 ± 39.0 | |
| Age (Mean ± SD) | 54.5 ± 14.8 | 59.6 ± 14.5 | 51.4 ± 19.8 | 56.9 ± 15.2 | <0.001 |
| Male (%) | 43.6% | 56.9% | 55.1% | 51.4% | <0.001 |
| Ethnicity | <0.001 | ||||
| White | 9989 (38.0%) | 17093 (55.8%) | 891 (43.3%) | 29824 (47.0%) | |
| Mixed Race (Pardo) | 10469 (39.9%) | 9043 (29.5%) | 735 (35.7%) | 21957 (34.6%) | |
| Black | 996 (3.8%) | 1185 (3.9%) | 76 (3.7%) | 2453 (3.9%) | |
| Yellow | 420 (1.6%) | 344 (1.1%) | 26 (1.3%) | 851 (1.3%) | |
| Unknown | 4387 (16.7%) | 2955 (9.7%) | 328 (16.0%) | 8341 (13.2%) | |
| Diabetes n(%) | 295 (1.1%) | 467 (1.5%) | 24 (1.2%) | 843 (1.3%) | <0.001 |
| Hypertension n(%) | 1129 (4.3%) | 1449 (4.7%) | 67 (3.3%) | 2808 (4.4%) | 0.001 |
| Dyslipidemia n(%) | 204 (0.8%) | 396 (1.3%) | 8 (0.4%) | 644 (1.0%) | <0.001 |
| Atrial Fibrillation n(%) | 174 (0.7%) | 193 (0.6%) | 12 (0.6%) | 424 (0.7%) | 0.840 |
| Renal Failure n(%) | 136 (0.5%) | 224 (0.7%) | 11 (0.5%) | 410 (0.6%) | 0.005 |
| Heart Failure n(%) | 1065 (4.1%) | 1485 (4.8%) | 81 (3.9%) | 3696 (5.8%) | <0.001 |
| COPD n(%) | 193 (0.7%) | 328 (1.1%) | 15 (0.7%) | 571 (0.9%) | 0.036 |
| PT/INR Monitorization n(%) | 695 (2.6%) | 1069 (3.5%) | 59 (2.9%) | 1959 (3.1%) | <0.001 |
| Length of Stay (Days) | 12.7 ± 10.2 | 12.6 ± 9.9 | 14.7 ± 12.3 | 13.0 ± 10.6 | <0.001 |
| Follow-Up (Days) (Median (IQR)) | 1107.0 (306.0–2250.0) | 999.0 (273.0–2171.2) | 938.0 (212.8–2157.2) | 1023.0 (277.0–2183.0) | <0.001 |
| ≥1-Year Follow-Up n(%) | 19098 (72.7%) | 21691 (70.8%) | 1419 (69.0%) | 45141 (71.2%) | |
| ≥5-Year Follow-Up n(%) | 9210 (35.1%) | 10157 (33.2%) | 646 (31.4%) | 21249 (33.5%) |
Figure 1
Spatial analysis of heart valve surgery in Brazil. Left: Surgical patient referral network and hospital hubs (top 2,000 flows; bubble size = PageRank influence). Center: Total volume of valve surgeries per hospital location. Right: Surgical in-hospital mortality rate by municipality.
Table 2
Mortality outcomes by etiological groups across multiple time horizons.
| ETIOLOGY_GROUP | TOTAL DEATHS (n) | OVERALL MORTALITY % | IN-HOSPITAL % (n) | 30-DAY % (n) | 1-YEAR % (n) | 5-YEAR % (n) | TOP ICD-10 CAUSE |
|---|---|---|---|---|---|---|---|
| Overall | 21130 | 33.3% | 8.6% (5451) | 10.0% (6331) | 19.6% (12424) | 30.1% (19108) | Mitral Stenosis |
| Degenerative | 10331 | 33.7% | 7.9% (2422) | 9.4% (2887) | 19.6% (6015) | 30.5% (9329) | Aortic Stenosis |
| Rheumatic | 8408 | 32.0% | 8.5% (2243) | 9.8% (2577) | 18.4% (4845) | 28.9% (7577) | Mitral Stenosis |
| Other | 1683 | 37.5% | 12.3% (553) | 13.6% (610) | 24.9% (1118) | 34.7% (1559) | Endocarditis |
| Congenital | 708 | 34.4% | 11.3% (233) | 12.5% (257) | 21.7% (446) | 31.3% (643) | Ebstein’s Anomaly |
Figure 2
Kaplan–Meier curves for cumulative long-term mortality according to valve disease etiology, with restricted mean survival time (RMST) shown for each etiological group. Log-rank test: p < 0.001.
Figure 3
Kaplan–Meier survival curves by valve lesion subtype in the rheumatic group. Landmark analysis at 30 days and five years. Reference: Mitral stenosis. Log-rank p < 0.001.
Figure 4
Kaplan–Meier survival curves by valve lesion subtype in the degenerative group.
Figure 5
Kaplan–Meier survival curves by valve lesion subtype in the congenital group. Estimates beyond five years should be interpreted with caution given limited follow-up.