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Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery

Jae-Kwan Song1, Mi-Jeong Kim, Sung-Cheol Yun

  • 1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jksong@amc.seoul.kr

The Journal of Thoracic and Cardiovascular Surgery
|August 8, 2009
PubMed

Insights

Open heart surgery demonstrated superior long-term event-free survival compared to percutaneous mitral valvuloplasty. Patients with severe mitral valve disease or atrial fibrillation particularly benefited from open heart surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Mitral valve disease is a significant cardiovascular condition.
  • Percutaneous mitral valvuloplasty (PMV) and open heart surgery (OHS) are primary treatment options.
  • Long-term comparative outcomes between PMV and OHS require further investigation.

Purpose of the Study:

  • To compare the long-term clinical outcomes of PMV versus OHS for mitral valve disease.
  • To identify patient subgroups that may benefit more from one procedure over the other.

Main Methods:

  • A cohort study evaluated 402 patients undergoing PMV and 159 patients undergoing OHS (1995-2000).
  • The primary endpoint was a composite of cardiovascular death or repeat intervention.
  • Outcomes were analyzed using Cox proportional hazards models, adjusting for baseline illness severity, echocardiographic scores, and cardiac rhythm.

Main Results:

  • Unadjusted event-free survival was similar between PMV and OHS groups.
  • Adjusted analysis revealed significantly higher event-free survival after OHS (adjusted hazard ratio: 3.729, P < .0001).
  • Patients with high echocardiographic scores (≥8) or atrial fibrillation showed substantially better outcomes with OHS (adjusted hazard ratios: 5.348 and 3.440, respectively).

Conclusions:

  • Open heart surgery is associated with superior long-term event-free survival compared to percutaneous mitral valvuloplasty.
  • OHS offers better long-term outcomes for patients with significant echocardiographic abnormalities or atrial fibrillation.
  • Patient selection based on disease severity and comorbidities is crucial for optimizing mitral valve intervention outcomes.
Abstract

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