Long-term follow-up of patients with percutaneous mitral commissurotomy

Percutaneous mitral commissurotomy (PMC) has become the procedure of choice for patients with isolated mitral stenosis.

To assess immediate and long-term results of PMC and identify predictors of event-free survival.

Percutaneous mitral commissurotomy was attempted in 1380 patients (mean age 49.36+/-10.0 years) with severe mitral stenosis.

Good immediate results defined as valve area > or =1.5 cm(2) without regurgitation >2+ were obtained in 1149 (83.3%) patients. The mean follow-up period was 8.2+/-6.4 (1-17) years. The event-free survival rate (alive, no mitral surgery, no repeat PMC) was 87.7, 75.6 and 69.7% at 5, 10 and 15 years respectively. Cox regression analysis identified old age (p=0.04), high echocardiographic score (p <0.0001), advanced NYHA class after PMC (p=0.005), low mitral valve area after PMC (p <0.0001), high gradient after PMC (p <0.0001), high pulmonary artery systolic pressure after PMC (p <0.0001), and >2+ mitral regurgitation after PMC (p <0.0001) as independent predictors of adverse outcome.

Percutaneous mitral commissurotomy has excellent immediate and long-term results for selected patients with mitral stenosis. Eight years after PMC most of the patients were in good clinical condition and free of any major event. The procedural result was the main determinant of long-term outcome. Prediction of late events is multifactorial. Knowledge of these predictors can improve patient selection and follow-up results.