Long-term follow-up of patients undergoing closed transventricular mitral commissurotomy: A useful surrogate for percutaneous balloon mitral valvuloplasty?

• Published in: Journal of the American College of Cardiology Vol. 20; no. 4; pp. 781 - 786
• Main Authors: Rihal, Charanjit S., Schaff, Hartzell V., Frye, Robert L., Bailey, Kent R., Hammes, LaVon N., Holmes, David R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1992; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Cardiology. Vascular system; Catheterization; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Humans; Life Tables; Male; Medical sciences; Mitral Valve - surgery; Mitral Valve Stenosis - epidemiology; Mitral Valve Stenosis - surgery; Mitral Valve Stenosis - therapy; Multivariate Analysis; Proportional Hazards Models; Reoperation; Time Factors; Treatment Outcome; Human; Mitral valve; Treatment; Cardiac valvular disease; Follow up study; Surgery; Cardiovascular disease; Narrowing; Commissurotomy; Technique
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(92)90172-J

Objective. The aim of this study was to determine the long-term outcome and multivarviate predictors of late events in patients who underwent transventricular mitral commissurotomy at the Mayo Clinic in the early 1960s. Background. Percutaneous balloon mitral valvuloplasty is an important new procedure for which long-term follow-up data are not yet available. However, such data do exist for patients who have undergone transventricular mitral commissurotomy, a similar but older and more invasive procedure. Methods. Follow-up data (mean duration 13.9 years) for 207 women and 60 men who underwent transventricular mitral commissurotomy were obtained from medical records, referring physicians, questionnaires and telephone interviews. Survival and survival free of repeat commissurotomy or mitral valve surgery were estimated with the Kaplan-Meier method. Cox proportional hazards model was used to determine predictors of survival and repeat mitral valve surgery. Results, Postoperatively, 92% of patients had symptomatic improvement, which was sustained for at least 3 to 4 years in 78%. At 10 15 and 20 years postoperatively, 79%, 67% and 55%, respectively, of patients were alive and 57%, 36% and 24%, respectively, were alive and free of repeat mitral valve surgery. At 10 years, 90% of all patients were free of transient or fixed cerebrovascular events. In multivariate analyses, atrial fibrillation, age and male gender were independently associated with death, whereas mitral valve calcification, cardiomegaly and mitral regurgitation independently predicted repeat mitral valve surgery. Conclusions. Long-term results after transventricular mitral commissurotomy are excellent in selected patients with symptomatic mitral stenosis. Because of similarities in patient selection and mechanisms of mitral valve dilation, similar favorable loag-term outcomes may be expected after percutaneous balloon mitral valvuloplasty.