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Comparison of balloon valvuloplasty with operative treatment for mitral stenosis
J M Cohen1, D D Glower, J K Harrison
1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Percutaneous balloon mitral valvuloplasty offers similar survival to open mitral commissurotomy and mitral valve replacement for mitral stenosis. However, it has a higher rate of subsequent mitral valve procedures, especially after prior commissurotomy.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Mitral stenosis management involves percutaneous balloon mitral valvuloplasty (PBMV), open mitral commissurotomy (OMC), and mitral valve replacement (MVR).
- Optimal selection among these procedures for mitral stenosis remains a critical clinical question.
Purpose of the Study:
- To compare the long-term outcomes of PBMV, OMC, and MVR in patients with mitral stenosis.
- To determine the optimal role of PBMV and OMC in the management of mitral stenosis.
Main Methods:
- A retrospective review of 164 consecutive patients undergoing PBMV, OMC, or MVR for mitral stenosis.
- Analysis of preoperative characteristics, symptom improvement, hospital stay, actuarial survival, and freedom from subsequent mitral valve procedures.
Main Results:
- Median hospital stays were significantly shorter for PBMV (2 days) compared to OMC (9 days) and MVR (10 days).
- Actuarial survival at 36 months did not differ significantly between the groups.
- Actuarial freedom from subsequent mitral valve procedures at 36 months was highest for MVR (100%), followed by OMC (87%), and PBMV (66%).
- Prior mitral commissurotomy increased the rate of subsequent procedures after PBMV.
Conclusions:
- PBMV offers a shorter hospital stay but a higher rate of reintervention compared to OMC and MVR.
- OMC provides good long-term results with a lower reintervention rate than PBMV.
- MVR offers the best freedom from reintervention but involves a longer hospital stay.
Abstract:
To determine the optimal role for percutaneous balloon mitral valvuloplasty or open mitral commissurotomy, the outcome of 164 consecutive patients undergoing either percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, or mitral valve replacement for mitral stenosis was reviewed. No preoperative differences existed between percutaneous balloon mitral valvuloplasty and open mitral commissurotomy in age, symptoms, or mitral valve characteristics. Symptoms improved similarly in all groups, and median hospital stays after procedures were 2, 9, and 10 days for percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, and mitral valve replacement (p < 0.005). Actuarial survivals at 36 months did not differ significantly (83% +/- 6%, 94% +/- 4%, and 90% +/- 4%). Actuarial freedoms from subsequent mitral valve procedures at 36 months were 66% +/- 7%, 87% +/- 6%, and 100% +/- 13% (p < 0.005), with the linearized rate of subsequent mitral valve procedures being 12% +/- 3%, 4% +/- 2%, and 1.2% +/- 0.8%/patient-year for percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, and mitral valve replacement (p < 0.01). Prior mitral commissurotomy increased the likelihood of subsequent mitral procedures after percutaneous balloon mitral valvuloplasty from 10% +/- 3% to 20% +/- 7%/patient-year.