Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery.
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.
Song
Jae-Kwan
JK
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jksong@amc.seoul.kr
Kim
Mi-Jeong
MJ
Yun
Sung-Cheol
SC
Choo
Suk Jung
SJ
Song
Jong-Min
JM
Song
Hyun
H
Kang
Duk-Hyun
DH
Chung
Cheol Hyun
CH
Park
Duk Woo
DW
Lee
Seung Whan
SW
Kim
Young-Hak
YH
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Kim
Jae-Joong
JJ
Lee
Jae Won
JW
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
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