BACKGROUND: Indications of percutaneous mitral commissurotomy (PMC) remain debated in calcific mitral stenosis. We analyzed long-term results of PMC for calcific mitral stenosis and the factors associated with late functional results. METHODS AND RESULTS: We compared the characteristics and outcome of 314 patients undergoing PMC for calcific mitral stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥ 1.5 cm(2) with mitral regurgitation ≤ 2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P < 0.001). The hazard ratio for good functional results (survival without cardiovascular death, without mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1-2.9]; P < 0.0001) in patients with calcified valves (12 ± 3% at 20 years) relative to the noncalcified group (38 ± 2% at 20 years). In the 251 patients with calcified valves who had good immediate results, 15-year rates of good functional results were 35 ± 4% for minor (grade 1) calcification, 24 ± 6% for grade 2, and 10 ± 6% for severe (grades 3-4) calcification. Factors associated with poor late functional results on multivariable analysis were calcification extent, older age, higher New York Heart Association class, atrial fibrillation, and higher mean gradient after PMC. CONCLUSIONS: Although late results of PMC are less satisfying in calcific mitral stenosis, long-term functional outcome depends on calcification extent, patient characteristics, and immediate results of PMC. These findings support the use of PMC as first-line treatment in selected patients with calcific mitral stenosis.
BACKGROUND: Indications of percutaneous mitral commissurotomy (PMC) remain debated in calcific mitral stenosis. We analyzed long-term results of PMC for calcific mitral stenosis and the factors associated with late functional results. METHODS AND RESULTS: We compared the characteristics and outcome of 314 patients undergoing PMC for calcific mitral stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥ 1.5 cm(2) with mitral regurgitation ≤ 2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P < 0.001). The hazard ratio for good functional results (survival without cardiovascular death, without mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1-2.9]; P < 0.0001) in patients with calcified valves (12 ± 3% at 20 years) relative to the noncalcified group (38 ± 2% at 20 years). In the 251 patients with calcified valves who had good immediate results, 15-year rates of good functional results were 35 ± 4% for minor (grade 1) calcification, 24 ± 6% for grade 2, and 10 ± 6% for severe (grades 3-4) calcification. Factors associated with poor late functional results on multivariable analysis were calcification extent, older age, higher New York Heart Association class, atrial fibrillation, and higher mean gradient after PMC. CONCLUSIONS: Although late results of PMC are less satisfying in calcific mitral stenosis, long-term functional outcome depends on calcification extent, patient characteristics, and immediate results of PMC. These findings support the use of PMC as first-line treatment in selected patients with calcific mitral stenosis.
Authors: Guilherme Rafael Sant'Anna Athayde; Bruno Ramos Nascimento; Sammy Elmariah; Lucas Lodi-Junqueira; Juliana Rodrigues Soares; Gabriel Prado Saad; Jose Luiz Padilha da Silva; Timothy C Tan; Judy Hung; Igor F Palacios; Robert A Levine; Maria Carmo Pereira Nunes Journal: Catheter Cardiovasc Interv Date: 2018-09-23 Impact factor: 2.692
Authors: Wilson W Li; David R Koolbergen; Berto J Bouma; Mark G Hazekamp; Bas A de Mol; Robbert J de Winter Journal: BMC Cardiovasc Disord Date: 2015-07-14 Impact factor: 2.298
Authors: Nan Phyu Sin Toe Myint; Ne Myo Aung; Myint Soe Win; Thu Ya Htut; Anna P Ralph; David A Cooper; Myo Lwin Nyein; Mar Mar Kyi; Josh Hanson Journal: PLoS One Date: 2018-02-21 Impact factor: 3.240
Authors: Jean Jacques Noubiap; Ulrich Flore Nyaga; Aude Laetitia Ndoadoumgue; Jan René Nkeck; Anderson Ngouo; Jean Joel Bigna Journal: Glob Heart Date: 2020-05-18