
Income, Geography, and Etiology as Factors Associated with Valve Replacement Outcomes: A Nationwide Cohort of 63,426 Patients in a Middle-Income Country
References
- Chen QF, Shi S, Wang YF, Shi J, Liu C, Xu T, et al. Global, regional, and national burden of valvular heart disease, 1990 to 2021. J Am Heart Assoc. 2024;13(24):
e037991 . DOI: 10.1161/JAHA.124.037991 - Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol. 2021;18(12):853–864. DOI: 10.1038/s41569-021-00570-z
- Karthikeyan G, Guilherme L. Acute rheumatic fever. Lancet. 2018;392(10142):161–174. DOI: 10.1016/S0140-6736(18)30999-1
- Kumar RK, Antunes MJ, Beaton A, Mirabel M, Nkomo VT, Okello E, et al. Contemporary diagnosis and management of rheumatic heart disease. Circulation. 2020;142(20):e337–e357. DOI: 10.1161/CIR.0000000000000921
- Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017;377(8):713–722. DOI: 10.1056/NEJMoa1603693
- Zilla P, Yacoub M, Zühlke L, Beyersdorf F, Sliwa K, Khubulava G, et al. Global unmet needs in cardiac surgery. Glob Heart. 2018;13(4):293–303. DOI: 10.1016/j.gheart.2018.08.002
- Zilla P, Bolman RM, Boateng P, Sliwa K. A glimpse of hope: cardiac surgery in low- and middle-income countries. Cardiovasc Diagn Ther. 2020;10(2):336–349. DOI: 10.21037/cdt.2019.11.03
- Figueiredo ET, Azevedo L, Rezende ML, Alves CG. Rheumatic fever: a disease without color. Arq Bras Cardiol. 2019;113(3):345–354. DOI: 10.5935/abc.20190141
- Zilli AC, Guizilini S, Rocco IS, do Espírito Santo JA, Berwanger O, Kalil RAK, et al. Valve heart surgery in Brazil: the BYPASS Registry analysis. Braz J Cardiovasc Surg. 2020;35(1):82–90. DOI: 10.21470/1678-9741-2019-0408
- Faleiro MD, Fernandez MG, Feitosa KIB, Vervoort D. Global cardiac surgery in Brazil: a call to action. Braz J Cardiovasc Surg. 2024;39(4):
e20230408 . DOI: 10.21470/1678-9741-2023-0408 - Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, et al. Contemporary presentation and management of valvular heart disease: the EURObservational Research Programme VHD II survey. Circulation. 2019;140(2):1156–1169. DOI: 10.1161/CIRCULATIONAHA.119.041080
- Siregar S, de Heer F, Groenwold RHH, Versteegh MIM, Bekkers JA, Brinkman ES, et al. Trends and outcomes of valve surgery: 16-year results of Netherlands cardiac surgery national database. Eur J Cardiothorac Surg. 2014;46(3):386–397. DOI: 10.1093/ejcts/ezu017
- Siregar S, Groenwold RH, de Mol BAJM, Speekenbrink RGH, Versteegh MIM, Bruinsma GJBB, et al. Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up? Eur J Cardiothorac Surg. 2013;44(5):875–883. DOI: 10.1093/ejcts/ezt119
- Lee R, Li S, Rankin JS, O’Brien SM, Gammie JS, Peterson ED, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011;91(3):677–684. DOI: 10.1016/j.athoracsur.2010.11.009
- Gomes WJ, Moreira RS, Zilli AC, Bettiati, LC,
Jr. , Dos Santos Figueira FAM, D’Azevedo SSP, et al. The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: results of the first 1,722 patients. Braz J Cardiovasc Surg. 2017;32(2):71–76. - Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, et al. Global mortality variations in patients with heart failure: results from the INTER-CHF study. Lancet Glob Health. 2017;5(7):e665–e672.
- Mbanze I, Spracklen TF, Jessen N, Damasceno A, Sliwa K. Heart failure in low-income and middle-income countries. Heart. 2025;111(8):341–351. DOI: 10.1136/heartjnl-2024-324176
- Østergaard L, Valeur N, Ihlemann N, Smerup MH, Bundgaard H, Gislason G, et al. Incidence and factors associated with infective endocarditis in patients undergoing left-sided heart valve replacement. Eur Heart J. 2018;39(28):2668–2675. DOI: 10.1093/eurheartj/ehy153
- Coube M, Nikoloski Z, Mrejen M, Mossialos E. Persistent inequalities in health care services utilisation in Brazil (1998–2019). Int J Equity Health. 2023;22(1):
25 . DOI: 10.1186/s12939-023-01828-3 - Ribeiro AL, Duncan BB, Brant LC, Lotufo PA, Mill JG, Barreto SM. Cardiovascular health in Brazil: trends and perspectives. Circulation. 2016;133(4):422–433. DOI: 10.1161/CIRCULATIONAHA.114.008727
- Thourani VH, Brennan JM, Edelman JJ, Thibault D, Jawitz OK, Bavaria JE, et al. Association of volume and outcomes in 234 556 patients undergoing surgical aortic valve replacement. Ann Thorac Surg. 2022;114(4):1299–1306. DOI: 10.1016/j.athoracsur.2021.06.095
- Alkhouli M, Alqahtani F, Cook CC. Association between surgical volume and clinical outcomes following coronary artery bypass grafting in contemporary practice. J Card Surg. 2019;34(10):1049–1054. DOI: 10.1111/jocs.14205
- Karthikeyan G, Ntsekhe M, Islam S, Rangarajan S, Avezum A, Benz A, et al. Mortality and morbidity in adults with rheumatic heart disease. JAMA. 2024;332(2):133–140. DOI: 10.1001/jama.2024.8258
- Zühlke L, Karthikeyan G, Engel ME, Rangarajan S, Mackie P, Mauff BC-K, et al. Clinical outcomes in 3343 children and adults with rheumatic heart disease from 14 low- and middle-income countries: two-year follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study). Circulation. 2016;134(19):1456–1466. DOI: 10.1161/CIRCULATIONAHA.116.024769
- Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: access to cardiac surgical care around the world. J Thorac Cardiovasc Surg. 2020;159(3):987–996.e6. DOI: 10.1016/j.jtcvs.2019.04.039
- Vervoort D, Swain JD, Pezzella AT, Kpodonu J. Cardiac surgery in low- and middle-income countries: a state-of-the-art review. Ann Thorac Surg. 2021;111(4):1394–1400. DOI: 10.1016/j.athoracsur.2020.05.181
DOI: https://doi.org/10.5334/gh.1581 | Journal eISSN: 2211-8179
Language: English
Page range: 63 - 63
Submitted on: Jun 16, 2026
Accepted on: Aug 13, 2026
Published on: Aug 25, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Keywords:
© 2026 Leonardo Dexheimer da Silva, João Luís Freitas, Felipe Dircêu Dantas Leite Pessôa, Elinthon Tavares Veronese, Carlos Manuel de Almeida Brandão, Roney O. Sampaio, Guilherme Sobreira Spina, Flávio Tarasoutchi, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.