Functional results 5 years after successful percutaneous mitral commissurotomy in a series of 528 patients and analysis of predictive factors

Objectives. This study sought to assess late functional results after successful percutaneous mitral commissurotomy and to determine their predictors. Background. Few studies have reported late results of percutaneous mitral commissurotomy or have analyzed their late results regardless of immediate results, despite the fact that late deterioration may well be related either to a decrease in valve area or to poor initial results. Methods. Between 1986 and 1992, 528 patients underwent successful percutaneous mitral commissurotomy (mean [ +/- SD] age 46 +/- 18 years; mean follow-up 32 +/- 18 months). A successful procedure was defined by a mitral valve area greater than or equal to 1.5 cm(2) and no regurgitation >2/4. Dilation was performed using a single balloon in 13 patients, a double baboon in 349 and the Inoue balloon in 166. Multivariate analysis,vas performed with a Cox model. Results. The survival rate for patients in New York Heart Association functional class I or II, with no cardiac-related deaths or need for mitral surgery or repeat dilation, was 76 +/- 6% at 5 years. By multivariate analysis, the independent predictors of good functional results were echocardiographic group (p = 0.01), functional class (p = 0.02) and cardiothoracic index (p = 0.005) before the procedure and valve area after the procedure (p = 0.007). The predictive model derived allowed estimation of the probability of good functional results according to the value of these four predictors for any given patient. Conclusions. Good functional results were observed 5 years after successful percutaneous mitral commissurotomy in a large series of varied patients. The analysis of predictive factors may provide useful indications for follow-up results in patients undergoing this technique.