title: Comparison of long-term outcome after mitral valve replacement or repeated balloon mitral valvotomy in patients with restenosis after previous balloon valvotomy.
abstract: Symptomatic mitral stenosis (MS) develops in 7% to 21% of patients after percutaneous mitral balloon valvotomy (PMV). Treatment options for these patients are surgical mitral valve replacement (MVR) or repeated PMV. However, no comparisons were made between these 2 procedures regarding long-term outcome. This retrospective study compares the long-term outcome of 888 patients with symptomatic MS after MVR or repeated PMV who underwent PMV from April 1988 to December 2003. Thirty-two patients subsequently underwent repeated PMV, and 59 patients underwent MVR for symptomatic MS. Mean follow-up was 85 +/- 43 months with a maximum follow-up of 15 years. Patients with MVR have more unfavorable clinical characteristics, including a higher incidence of atrial fibrillation and severe mitral regurgitation. Event-free survival was similar between the 2 groups up to 40 months after the procedure; 3-year event-free survival rates were 96.6% for MVR patients and 90.0% for repeated PMV patients (p = 0.215). However, after 40 months, the outcome was more favorable for MVR. Comparing MVR versus PMV, 6-year event-free survival rates were 93.0% versus 75.9% (p = 0.036), and 9-year event-free survival rates were 90.4% versus 36.0% (p <0.001). In conclusion, the long-term outcome of patients with symptomatic MS after previous PMV was more favorable after MVR than after repeated PMV. These data suggest that MVR may be the preferred mode of therapy in patients with unfavorable valve morphologic characteristics and no co-morbid disease.
authors.affiliation: Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jin-Bae
authors.initials: JB
authors.lastname: Kim
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Won-Heum
authors.initials: WH
authors.lastname: Shim
authors.forename: Seok-Min
authors.initials: SM
authors.lastname: Kang
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
authors.forename: Seung-Yun
authors.initials: SY
authors.lastname: Cho
authors.forename: Sung-Soon
authors.initials: SS
authors.lastname: Kim
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology; D002404:Catheterization; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012107:Research Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome