Abstract
Late functional deterioration after percutaneous mitral valvuloplasty (PMV) has raised the issue of comparing long-term outcomes between PMV and open-heart surgery (OHS). The study evaluated 402 patients who underwent PMV and 159 patients who underwent OHS between January 1, 1995, and December 31, 2000. The rates of cardiovascular death or repeated intervention (redo-PMV or OHS) were determined over a median follow-up of 109 months (mean±SD 106±27). The therapeutic effects on adverse outcomes were estimated using Cox’s proportional hazards model adjusting differences in the severity of illness before intervention, and the effects of the cardiac rhythm and echocardiographic score were also tested. The observed (unadjusted) event-free survival rate was similar for both groups, and the hazard ratio for the clinical events after PMV as compared with after OHS was 1.510 (95% confidence interval [CI], 0.914 –2.496, p=0.1079). However, the adjusted hazard ratio was 3.729 (95% CI, 1.963–7.082, p<0.0001), showing a higher event-free survival rate in the OHS group. The adjusted hazard ratios after PMV as compared with after OHS in patients with echocardiographic scores ≥8 and atrial fibrillation were 5.348 (95% CI, 2.504 –11.422, p<0.001) and 3.440 (95% CI, 1.805– 6.555, p=0.0002), respectively, whereas the hazard ratios in patients with echocardiographic scores <8 and normal sinus rhythm did not show differences. OHS was associated with a higher adjusted rate of long-term event-free survival than PMV. Patients with high echocardiographic scores or atrial fibrillation showed better outcomes after OHS.
Published Version
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