Percutaneous mitral commissurotomy for restenosis after surgical commissurotomy: late efficacy and implications for patient selection.
OBJECTIVE
The results of percutaneous mitral commissurotomy were assessed in patients with restenosis after surgical commissurotomy.


BACKGROUND
Balloon dilation is feasible in patients with restenosis after surgical commissurotomy, but little is known about its late efficacy.


METHODS
We studied 232 patients who had undergone percutaneous mitral commissurotomy a mean of 16 +/- 8 years after surgical commissurotomy. Mean age was 47 +/- 14 years; 81 patients (35%) had valve calcification. All patients had restenosis with bilateral commissural fusion as assessed by echocardiography. Technical failure occurred in 9 patients and the procedure used a single balloon in 7 patients, a double balloon in 95, and the Inoue balloon in 121.


RESULTS
Complications were death in 1 patient (0.4%) and mitral regurgitation >2/4 in 10 (4%); 191 patients (82%) had good immediate results (valve area > or =1.5 cm2 without regurgitation >2/4). Predictors of poor immediate results in multivariate analysis were older age (p < 0.001), lower initial valve area (p = 0.01) and the use of the double-balloon technique (p = 0.015). In the 175 patients who underwent follow-up, 8-year survival without operation and in New York Heart Association class I or II was 48 +/- 5%, and 58 +/- 6% after good immediate results. In this latter group, poor late functional results were predicted by higher cardiothoracic index (p < 0.0001), previous open-heart commissurotomy (p = 0.05) and lower final valve area (p < 0.0001) in a multivariate Cox model.


CONCLUSIONS
Percutaneous mitral commissurotomy is safe and provides good immediate results in selected patients with restenosis after surgical commissurotomy. After good immediate results, the conditions of more than half of the patients remained improved at 8 years, enabling reoperation to be deferred.
Iung
B
B
Cardiology Department, Tenon Hospital, Paris, France. bernard.iung001@wanadoo.fr
Garbarz
E
E
Michaud
P
P
Mahdhaoui
A
A
Helou
S
S
Farah
B
B
Berdah
P
P
Michel
P L
PL
Makita
Y
Y
Cormier
B
B
Luxereau
P
P
Vahanian
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome