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 event-free 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 results. 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 < or = 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.
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 event-free 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 results. 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 < or = 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.
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Authors: M Ben Farhat; M Ayari; F Maatouk; F Betbout; H Gamra; M Jarra; M Tiss; S Hammami; R Thaalbi; F Addad Journal: Circulation Date: 1998-01-27 Impact factor: 29.690
Authors: D J Cohen; R E Kuntz; S P Gordon; R N Piana; R D Safian; R G McKay; D S Baim; W Grossman; D J Diver Journal: N Engl J Med Date: 1992-11-05 Impact factor: 91.245
Authors: J P Bassand; F Schiele; Y Bernard; T Anguenot; M Payet; S A Ba; J P Daspet; J P Maurat Journal: J Am Coll Cardiol Date: 1991-10 Impact factor: 24.094
Authors: M Nobuyoshi; N Hamasaki; T Kimura; H Nosaka; H Yokoi; H Yasumoto; H Horiuchi; H Nakashima; T Shindo; T Mori Journal: Circulation Date: 1989-10 Impact factor: 29.690
Authors: Darae Kim; Hyemoon Chung; Jong Ho Nam; Dong Hyuk Park; Chi Young Shim; Jung Sun Kim; Hyuk Jae Chang; Geu Ru Hong; Jong Won Ha Journal: Yonsei Med J Date: 2018-03 Impact factor: 2.759