Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country

Abstract

IntroductionRheumatic mitral stenosis continues to be prevalent in developing countries, notably in endemic areas. Over the last few decades, percutaneous balloon mitral valvuloplasty (PBMV) has been established as a lower-cost alternative treatment for mitral stenosis (MS) in low-to-middle-income countries. PBMV has also been suggested to be an effective and safe alternative treatment modality. This study aims to analyse the survival of rheumatic MS patients treated with PBMV compared with those treated with mitral valve surgery (MVS).MethodsThis study was a national, single-centre, longitudinal study using a survival analysis method in 329 consecutive patients suffering from rheumatic heart disease with severe MS who underwent PBMV compared with 142 consecutive patients with similar characteristics who underwent MVS between January 2011 and December 2016. Survival analysis and event-free duration were determined over a median follow-up of 24 months in the PBMV group and 27 months in the MVS group.ResultsThe results showed that of the 329 consecutive patients in the PBMV group, 61 patients (18.5) had an event (6 patients died and 55 patients were hospitalised), and of the 142 consecutive patients in the MVS group, 19 patients (13.4%) had an event (5 patients died, and 14 patients were hospitalised). The hazard ratio was 0.631 (95% confidence interval, 0.376–1.058; P = 0.081). Longer short-term survival was found in the MVS group but was not statistically significant. Event-free survival was significantly longer in the MVS group (P = 0.002), by 5 months.ConclusionsIn this study, the efficacy and safety of PBMV was reconfirmed, as PBMV proved to be non-inferior to MVS in survival prognosis, but sustained event-free duration was significantly better in the MVS group than in the PBMV group.

Rheumatic heart disease anno 2020: Impacts of gender and migration on epidemiology and management

“…21,22 Percutaneous balloon mitral valvuloplasty is a safe and effective management for rheumatic MS. It has excellent procedural success rate (defined by the composite endpoint of a final mitral valve area ≥1.5 cm 2 without mitral regurgitation [MR] of more than grade 2) of 90% to 95% [23][24][25] with good immediate 26 and long-term outcomes 21,22 ; event-free survival rate of 90% at 5-7 years, 27 61% to 96% at 10 years [28][29][30] and 43% to 79% at 15 years. 25,28 For this reason, PBMV is considered standard of care for selected patients with rheumatic MS with Wilkins score <8 and mild MR. 21,22 Wilkins score 31 is an echocardiographic method used to predict the success of PBMV in the setting of rheumatic MS.…”

Clinical Cardiology in South East Asia: Indonesian Lessons from the Present towards Improvement

“…(69.4%) were women, with a mean age of 39.3 -41.2 years, 18% had hypertension, and 8.1% complicated with DM type 2 [25].…”

“…In Indonesia, the baseline characteristics were in agreement with the results from the REMEDY study [ 24 ]. Recent study by Ambari et al showed that among RHD patients with mitral stenosis in Indonesia, majority (69.4%) were women, with a mean age of 39.3 – 41.2 years, 18% had hypertension, and 8.1% complicated with DM type 2 [ 25 ].…”

Randomised controlled trial into the role of ramipril in fibrosis reduction in rheumatic heart disease: the RamiRHeD trial protocol

“…1 In the past 5 years, approximately 471 patients with rheumatic mitral stenosis were treated in our centre. 2 Treatments provided for RHD in advanced stages are relatively expensive for developing nations; thus, early detection and targeted treatment can greatly aid. 3 Mitral valve stenosis is the main presentation of RHD, commonly developing as a result of persistent or recurrent valvulitis with bicommissural fusion.…”