title: Late results of percutaneous mitral commissurotomy up to 20 years: development and validation of a risk score predicting late functional results from a series of 912 patients.
abstract: BACKGROUND
  Long-term follow-up after percutaneous mitral commissurotomy enables predictive factors of late results to be identified.
  
  
  RESULTS
  Late results of percutaneous mitral commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm(2) without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral commissurotomy and in New York Heart Association class I or II) was 30.2 ± 2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient (P<0.0001), interaction between age and final mitral valve area (P<0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification (P<0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation (P<0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort.
  
  
  CONCLUSIONS
  Twenty years after percutaneous mitral commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.
authors.affiliation: Cardiology Department, AP-HP, Bichat Hospital, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouleti
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Cédric
authors.initials: C
authors.lastname: Laouénan
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.forename: Delphine
authors.initials: D
authors.lastname: Détaint
authors.forename: Eric
authors.initials: E
authors.lastname: Garbarz
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Michel
authors.forename: France
authors.initials: F
authors.lastname: Mentré
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000453:epidemiology / Q000209:etiology; D002138:Calibration; D002404:Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional