Predictors of event-free survival after percutaneous mitral commissurotomy.
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.


METHODS
Analysis of clinical, echocardiographic, and haemodynamic variables at baseline and after the procedure by univariate and multivariate analyses (Cox model).


METHODS
University hospital.


METHODS
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.
Meneveau
N
N
Service de Cardiologie, Hôpital Universitaire Saint-Jacques, Besancon, France.
Schiele
F
F
Seronde
M F
MF
Breton
V
V
Gupta
S
S
Bernard
Y
Y
Bassand
J P
JP
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002404:Catheterization; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D008946:Mitral Valve Stenosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate