Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

Abstract

Background— Long-term follow-up after percutaneous mitral commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm 2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P <0.0001), interaction between age and final mitral valve area ( P <0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification ( P <0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation ( P <0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort. Conclusions— Twenty years after percutaneous mitral commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.

Resultados a largo plazo de la valvuloplastía mitral con balón

“…Es así como Olmos y cols publicaron el año 1994 en esta revista los datos de 300 VMB realizadas en nuestro medio, confirmando los buenos resultados difundidos en la literatura 9 . Al igual que ésta, existen varias publicaciones internacionales con resultados a mediano plazo 10,11,12,13 , pero sólo unas pocas presentan datos con 10 o más años de seguimiento 14,15,16 . De esta forma, en nuestro conocimiento este trabajo representa el seguimiento más prolongado de una serie nacional de VMB.…”

“…En el seguimiento a largo plazo, encontramos que 39,1% de los pacientes estaban vivos, en CF I o II y sin necesidad de nuevas intervenciones luego de un promedio de 13,5 años. Estos resultados son comparables a los encontrados por Bouleti y Fawzy 15,16 quienes han publicado sobrevida libre de eventos en seguimientos de hasta 20 años de 34,4% y 42%, respectivamente.…”

“…Este modelo ha sido replicado en otras publicaciones 7,12,15,16 y se encuentra ampliamente reconocido como un buen indicador del resultado global de la VMB. Sin embargo, puede tender a sobreestimar la tasa de eventos.…”

The Echo Score Revisited

“…Consistent with previous studies, long-term outcome was strongly determined by age and the quality of immediate results. [43][44][45][46][47][48] Age was the only predictor of adverse outcome among the preprocedural factors, whereas immediate post-PMV MR, pulmonary artery pressure, and transvalvular gradient were associated with event-free survival. The morphology of the mitral valve was not an independent predictor of long-term outcome when adjusted for age and postprocedural hemodynamic data.…”

“…[43][44][45][46][47][48] Our study enrolled a heterogeneous population including older patients with long-standing disease and lessfavorable valve anatomy. Consistent with previous studies, long-term outcome was strongly determined by age and the quality of immediate results.…”