ABC | Volume 113, Nº4, October 2019

Original Article Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease Renata Cristina Castro Cruz, 1 Bruna Silva Cordeiro, 2 Felipe de Souza Santos, 3 Caroline Rodrigues Fernandes, 3 Julia Maria Alves Gama, 1 Ana Marice Teixeira Ladeia 1 Escola Bahiana de Medicina e Saúde Pública, 1 Salvador, BA – Brazil Faculdade de Tecnologia e ciências, 2 Salvador, BA – Brazil Universidade Federal da Bahia, 3 Salvador, BA – Brazil Mailing Address: Renata Cristina Castro Cruz • Rua Waldemar Falcão, 1695, apt. 1501 - Norte. Postal Code 40295-010, Horto Florestal, BA – Brazil E-mail: rennatacruz@yahoo.com.br , rennatacruz@gmail.com Manuscript received May 30, 2018, revised manuscript December ado em 19/12/2018, aceito em 23/01/2019 DOI: 10.5935/abc.20190184 Abstract Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results. Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease. Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant. Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1–2 days). The logistic regressionmodel was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion: The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes. (Arq Bras Cardiol. 2019; 113(4):748-756) Keywords: Heart Defects,Congenital; Mitral Valve Insufficiency/surgery; Hypertension,Pulmonary; Reoperation; Tricuspid Valve Insufficiency/surgery; Cardiopathy, Rheumatic. Introduction Chronic rheumatic heart disease (RHD) consists of a non‑suppurative complication of rheumatic fever (RF), with uni‑ or multivalvar involvement, which can lead to severe heart failure. 1 It is estimated that each year there are 470,000 new cases of RF and 233,000 deaths attributed to RF or RHD. 2 Mitral valve regurgitation is the main cause of RHD in children; 3,4 when moderate or severe rheumatic valve disease is associated with pulmonary hypertension and left ventricular dysfunction, the development of congestive heart failure suggests the need for surgical intervention. 3 Chronic rheumatic disease and its complications generated, in Brazil, 6,648 hospitalizations and a cost of BRL 73,067,919.52 in 2017 alone. 5 Problems inherent to mitral valve replacement include the need for long-term anticoagulation, risk of bleeding, thromboembolism, endocarditis and lack of growth potential of the prosthesis, which makes the mitral valve plasty (MVP) technique superior to valve replacement in pediatric patients. 6,7 However, patients submitted to valvuloplasty had a higher reoperation rate in the short term. 8 This study aimed to identify predictors of unfavorable outcome in children and adolescents submitted to mitral valvuloplasty secondary to rheumatic heart disease. 748