Relationship between valve calcification and long-term results of percutaneous mitral commissurotomy for rheumatic mitral stenosis.
BACKGROUND
Indications of percutaneous mitral commissurotomy (PMC) remain debated in calcific mitral stenosis. We analyzed long-term results of PMC for calcific mitral stenosis and the factors associated with late functional results.


RESULTS
We compared the characteristics and outcome of 314 patients undergoing PMC for calcific mitral stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥ 1.5 cm(2) with mitral regurgitation ≤ 2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P < 0.001). The hazard ratio for good functional results (survival without cardiovascular death, without mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1-2.9]; P < 0.0001) in patients with calcified valves (12 ± 3% at 20 years) relative to the noncalcified group (38 ± 2% at 20 years). In the 251 patients with calcified valves who had good immediate results, 15-year rates of good functional results were 35 ± 4% for minor (grade 1) calcification, 24 ± 6% for grade 2, and 10 ± 6% for severe (grades 3-4) calcification. Factors associated with poor late functional results on multivariable analysis were calcification extent, older age, higher New York Heart Association class, atrial fibrillation, and higher mean gradient after PMC.


CONCLUSIONS
Although late results of PMC are less satisfying in calcific mitral stenosis, long-term functional outcome depends on calcification extent, patient characteristics, and immediate results of PMC. These findings support the use of PMC as first-line treatment in selected patients with calcific mitral stenosis.
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France.
Claire
C
Bouleti
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France. bernard.iung@bch.aphp.fr.
Bernard
B
Iung
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France.
Dominique
D
Himbert
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France.
David
D
Messika-Zeitoun
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France.
Eric
E
Brochet
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France.
Eric
E
Garbarz
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France.
Bertrand
B
Cormier
From the Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France.
Alec
A
Vahanian
D000328:Adult; D000368:Aged; D063126:Balloon Valvuloplasty / Q000379:methods*; D002114:Calcinosis / Q000175:diagnosis / Q000473:pathology*; D006328:Cardiac Catheterization / Q000379:methods*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
balloon valvuloplasty; mitral valve stenosis