title: Reinterventions after percutaneous mitral commissurotomy during long-term follow-up, up to 20 years: the role of repeat percutaneous mitral commissurotomy.
abstract: OBJECTIVE
  We analysed reinterventions performed during long-term follow-up after percutaneous mitral commissurotomy (PMC) with a particular focus on freedom from mitral surgery and late results of repeat PMC.
  
  
  RESULTS
  In 912 patients who had good immediate results of PMC (valve area ≥1.5 cm² with mitral regurgitation ≤2/4), we analysed survival without reintervention (surgery or repeat PMC) and survival without surgery alone, with a follow-up up to 20 years. The median age was 48 years, and 251 patients (27%) had calcified valves. During a median follow-up of 12 years, 351 patients (38%) underwent a reintervention: surgery was performed in 266 (76%) patients and repeat PMC in 85 (24%). Cardiovascular survival without reintervention (surgery or repeat PMC) was 38 ± 2% at 20 years. When analysing cardiovascular survival without surgery, this rate increased to 46 ± 2% at 20 years. In the 504 patients aged <50 years at the time of their initial PMC, 20-year rates were 45 ± 3% for cardiovascular survival without reintervention and 57 ± 3% for cardiovascular survival without surgery. Of the 85 patients who underwent repeat PMC, cardiovascular survival without surgery was 60 ± 7% at 10 years.
  
  
  CONCLUSIONS
  After successful PMC, reintervention is frequently needed. However, almost half of the patients remained free from surgery at 20 years. Repeat PMC was performed in one out of four cases of reintervention in this study, thereby allowing for postponement of surgery in a substantial number of patients.
authors.affiliation: Cardiology Department, AP-HP, Bichat University Hospital, 46 rue Henri Huchard, Paris 75018, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouleti
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
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: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D018579:Patient Selection; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D057832:Watchful Waiting
keywords: Balloon commissurotomy; Mitral stenosis; Mitral valve surgery