title: Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery.
abstract: OBJECTIVE
  We sought to compare long-term outcomes between percutaneous mitral valvuloplasty and open heart surgery.
  
  
  METHODS
  The study evaluated 402 patients who underwent percutaneous mitral valvuloplasty and 159 patients who underwent open heart surgery between January 1, 1995, and December 31, 2000. The rates of cardiovascular death or repeated intervention (redo percutaneous mitral valvuloplasty or open heart surgery) were determined over a median follow-up of 109 months (mean + or - SD, 106 + or - 27). The therapeutic effects on adverse outcomes were estimated by the Cox proportional hazards model adjusting differences in the severity of illness before intervention. The effects of the cardiac rhythm and echocardiographic score were also tested.
  
  
  RESULTS
  The observed (unadjusted) event-free survival was similar for both groups, and the hazard ratio for the clinical events after percutaneous mitral valvuloplasty as compared with after open heart surgery was 1.510 (95% confidence interval, 0.914-2.496; P = .1079). However, the adjusted hazard ratio was 3.729 (95% confidence interval, 1.963-7.082; P < .0001), showing a higher event-free survival in the open heart surgery group. The adjusted hazard ratio after percutaneous mitral valvuloplasty as compared with after open heart surgery in patients with echocardiographic scores of 8 or more and atrial fibrillation were 5.348 (95% confidence interval, 2.504-11.422; P < .001) and 3.440 (95% confidence interval, 1.805-6.555; P = .0002), respectively, whereas the hazard ratio in patients with echocardiographic scores less than 8 and normal sinus rhythm did not show differences.
  
  
  CONCLUSIONS
  Open heart surgery was associated with a higher adjusted rate of long-term event-free survival than percutaneous mitral valvuloplasty. Patients with high echocardiographic scores or atrial fibrillation showed better outcomes after open heart surgery.
authors: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jksong@amc.seoul.kr
authors: Jae-Kwan
authors: JK
authors: Song
authors: Mi-Jeong
authors: MJ
authors: Kim
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Suk Jung
authors: SJ
authors: Choo
authors: Jong-Min
authors: JM
authors: Song
authors: Hyun
authors: H
authors: Song
authors: Duk-Hyun
authors: DH
authors: Kang
authors: Cheol Hyun
authors: CH
authors: Chung
authors: Duk Woo
authors: DW
authors: Park
authors: Seung Whan
authors: SW
authors: Lee
authors: Young-Hak
authors: YH
authors: Kim
authors: Cheol Whan
authors: CW
authors: Lee
authors: Myeong-Ki
authors: MK
authors: Hong
authors: Jae-Joong
authors: JJ
authors: Kim
authors: Jae Won
authors: JW
authors: Lee
authors: Seong-Wook
authors: SW
authors: Park
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D016896:Treatment Outcome