160: What are long-term results of percutaneous mitral commissurotomy in patients with few or no symptoms?

Abstract

Percutaneous mitral commissurotomy (PMC) has enabled patients (pts) to be treated at an earlier stage of their disease than by surgery. However, very long-term results have not been specifically studied in this context. From 1986 to 1995, 237 patients in NYHA class I or II underwent PMC in our department. Mean age was 46±12 years; 74 patients (31%) had atrial fibrillation and 22 (9%) had a history of commissurotomy. Most patients were in NYHA class II (232 pts, 98%). As assessed by echocardiography, mean valve area was 1.1±0.2 cm 2 (≤1.5 cm 2 in all cases); 40 patients (17%) had pliable valves and mild subvalvular disease, 145 (61%) had severe subvalvular disease, and 52 (22%) had calcified valves. PMC used a singleballoon in 5 pts, a double-balloon in 93 and the Inoue balloon in 139. After PMC, valve area increased to 1.9±0.3 cm 2 as assessed by 2D echo. Severe mitral regurgitation (grade ≥3/4) occurred in 4 patients (1.7%). There were no other severe immediate complications. Good immediate results (valve area ≥1.5 cm 2 without mitral regurgitation >2/4) were obtained in 223 patients (94%). The 20-year actuarial rate of survival without surgery or repeat PMC and in NYHA class I or II was 41±4% in the whole population. After good immediate results, the 20-year rate of good functional results was 42±3%. A Cox multivariate model identified 2 predictors of good late functional results after good immediate results: young age (p=0.05) and a large valve area after PMC (p=0.002). In the 142 patients aged ≤50 years, the 20-rate of good functional results was 50±6%.