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Heart 1998;80:359-364; doi:10.1136/hrt.80.4.359
Copyright © 1998 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1998;80:359-364 ( October )

Predictors of event-free survival after percutaneous mitral commissurotomy

N Meneveau, F Schiele, M-F Seronde, V Breton, S Gupta, Y Bernard, J-P Bassand

Service de Cardiologie, Hôpital Universitaire Saint-Jacques, 2 place Saint Jacques, 25000 Besancon Cedex, France

Correspondence to: Dr Bassand. email: jean-pierre.bassand{at}ufc-chu.univ-fcomte.fr

Accepted for publication 26 June 1998

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 result. 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 =< 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.

Keywords: valvoplasty;  mitral valve stenosis

© 1998 by Heart
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