Predictors of event-free survival after percutaneous mitral commissurotomy

Abstract

Objective-To assess the long term functional result after percutaneous mitral commissurotomy and identify the predictors of event-free survival following 10 years of experience. Design-Analysis of clinical, echocardiographic, and haemodynamic variables at baseline and after the procedure by univariate and multivariate analyses (Cox model). Setting-University hospital. Patients-532 consecutive patients receiving percutaneous mitral commissurotomy in the same institution. Results-The mean (SD) follow up was 3.8 (4.0) years. Survival at 3, 5, and 7.5 years was 94%, 91%, and 83%, respectively; event-free survival was 84%, 74%, and 52%. Mitral valve anatomy was identified as the strongest independent predictor of eventfree survival. Age, cardiothoracic ratio, mean pulmonary artery pressure, and mean echocardiographic mitral gradient after commissurotomy were also found to be independent predictors of long term functional result. Event-free survival was 92%, 84%, and 70% at 3, 5, and 7.5 years in patients with favourable anatomy (echo score = 1), 86%, 73%, and 34% in patients with intermediate anatomy (echo score = 2), and 45%, 25%, and 16% in patients with unfavourable anatomy (echo score = 3). In patients aged < 65 years, the event-free survival rate was 80%, 70%, and 45% at 3, 5, and 7.5 years v 52%, 38%, and 17% in patients aged > 65 years. Conclusions-The anatomical form of the mitral valve and the patient's age were the most powerful predictors of event-free survival. Patients with intermediate or unfavourable anatomy and those aged > 65 years have low 5 and 7.5 year event-free survival rates. This must be taken into account when discussing the indications for percutaneous mitral commissurotomy; immediate mitral valve replacement is a reasonable alternative to balloon mitral commissurotomy in patients with higher risk of functional deterioration after the procedure. (Heart 1998;80:359-364)

Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

“…The most commonly reported independent predictors of post-PMV clinical events (cardiovascular death, mitral valve surgery and repeat PMV) and restenosis are echo score and post-PMV MVA, both related to mitral valve anatomy. 2,6,7,12,23 However, our results are in agreement with similar studies that also identified mPAP as an independent predictor of event-free survival. 2,6 Differences in the definition of endpoints and in baseline population characteristics may explain the different predictors reported in the literature.…”

“…2,3,9---11 Cardiac surgery may still be required for patients with post-procedural restenosis of the mitral orifice or increasing severity of mitral regurgitation (MR). 6 In this study, we sought to characterize a cohort of patients undergoing PMV at a single institution and to perform a long-term clinical follow-up to assess the predictors of post-PMV mitral intervention and clinical event-free survival. 12 Written informed consent was obtained from all patients prior to PMV.…”

“…Os doentes que necessitaram de reintervenção mitral durante o seguimento clínico eram mais novos (43,3 vs. 51,2 anos, p = 0,04), tinham gradientes transmitrais pré e pós-PMV mais elevados (14,9 vs. 11,5 mmHg, p = 0,02 e 6,4 vs. 2,1 mmHg, p < 0,001) e uma pressão média na artéria pulmonar (mPAP) pós-PMV mais elevada (30,0 vs. 23,2 mmHg, p = 0,01). No modelo de regressão logística de Cox a mPAP ≥ 25 mmHg foi o único preditor de reintervenção mitral (HR 5,639 [1,5], p = 0,025) e de eventos clínicos (HR 3,6 [1,(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)3], p = 0,039). Conclusão: Na população estudada, a mPAP medida imediatamente após a valvuloplastia mitral foi o único preditor de reintervenção mitral.…”

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.…”

“…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.…”