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Outcomes of Patients With Mitral Stenosis With Prior Percutaneous Mitral Commissurotomy Undergoing Mitral Valve

Nattanon Ruangsubvilai1, Krittapas Au-Yeung1, Chawalit Wongbuddha2

  • 1Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

The American Journal of Cardiology
|January 21, 2026
PubMed

Insights

Prior percutaneous mitral commissurotomy (PMC) in rheumatic mitral stenosis (MS) patients undergoing surgical mitral valve replacement (MVR) did not increase long-term mortality. However, patients with prior PMC faced higher risks of mitral reintervention and stroke/transient ischemic attack.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Limited data exist on outcomes for patients with mitral stenosis (MS) who have undergone percutaneous mitral commissurotomy (PMC) before surgical mitral valve replacement (MVR).
  • Rheumatic MS is a significant cause of valvular heart disease globally, often requiring intervention.
  • Understanding the impact of prior PMC on subsequent MVR outcomes is crucial for treatment planning.

Purpose of the Study:

  • To evaluate the impact of prior percutaneous mitral commissurotomy (PMC) on clinical outcomes in rheumatic mitral stenosis (MS) patients undergoing surgical mitral valve replacement (MVR).
  • To compare long-term mortality, mitral reintervention, heart failure rehospitalization, stroke/transient ischemic attack, and bleeding between patients with and without prior PMC.

Main Methods:

  • Retrospective cohort study comparing rheumatic MS patients who underwent surgical MVR between 2010 and 2020.
  • Patients were divided into two groups: those with a history of prior PMC and those without.
  • Primary outcome was 5-year all-cause mortality; secondary outcomes included mitral reintervention, rehospitalization for heart failure, stroke/TIA, and major bleeding.

Main Results:

  • Among 1137 patients, 77 (6.8%) had prior PMC. Patients with prior PMC were more often female and had a lower baseline mitral valve pressure gradient.
  • No significant difference in 5-year all-cause mortality was observed between the prior PMC group and the no-prior-PMC group (20.5% vs. 17.6%, p=0.614).
  • Rates of mitral reintervention (3.9% vs. 0.8%, p=0.014) and stroke/TIA (5.2% vs. 0.9%, p=0.002) were significantly higher in the prior PMC group. Rehospitalization for heart failure and major bleeding were similar.

Conclusions:

  • Prior percutaneous mitral commissurotomy (PMC) does not increase long-term mortality in rheumatic mitral stenosis (MS) patients undergoing surgical mitral valve replacement (MVR).
  • PMC appears safe as an initial treatment strategy for selected rheumatic MS patients.
  • The increased risk of mitral reintervention and stroke/transient ischemic attack following MVR in patients with prior PMC necessitates careful long-term monitoring.
Keywords:
mitral stenosismitral valve replacementpercutaneous mitral commissurotomy

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