Mitral valve repair after failed percutaneous mitral commissurotomy was achieved in 62.3% of patients, yielding 82.7% 20-year survival and fewer valve-related events than replacement.
Cohort (n=61)
Does mitral valve repair improve long-term outcomes compared to replacement in patients requiring surgery after failed percutaneous mitral commissurotomy?
Mitral valve repair is feasible in a majority of patients after failed percutaneous mitral commissurotomy and is associated with excellent long-term survival and fewer valve-related events compared to replacement.
OBJECTIVES: Due to progression of rheumatic disease, percutaneous mitral commissurotomy (PMC) is a palliative procedure. We aimed at evaluating the outcomes of patients requiring surgery for failure of PMC, focusing on the fate of the mitral valve (MV) (repair versus replacement). METHODS: From January 1993 through December 2012, 61 patients with previous PMC were submitted to MV surgery. Detailed operative findings were collected from all patients and an intraoperative anatomical score was introduced to predict reparability. Time to surgery, overall survival and freedom from reoperation were analysed. RESULTS: The mean time to surgery after PMC was 6.9±5.9 years and indications were restenosis in 25 patients (41%) and mitral regurgitation or mixed lesion in 36 (59%). Nine patients (14.8%) had more than one previous intervention. Intraoperative inspection of the valve revealed leaflet laceration outside the commissural area in 27 patients (44.3%). Valve repair was accomplished in 38 patients (62.3%). Pulmonary hypertension, calcification and intraoperative anatomical score were independently associated with the probability of valve replacement (OR 1.12, OR 7.03 and OR 4.49, respectively, P<0.05). There was no hospital mortality. MV area increased on average 1.6 cm2 after surgery to 2.7 cm2; 5-, 10- and 20-year survival rates were 98.1±1.9, 91±5.2 and 82.7±9.2%, respectively. The rate of freedom from mitral reoperation (for repaired cases) at 5, 10 and 15 years was 100, 95.8±4.1 and 87.8±8.5%, respectively. There was no difference in survival between repaired or replaced MVs, but the former had less valve-related events during follow-up. CONCLUSION: The MV can be repaired after failed PMC, with very low complication rates and excellent long-term results. Hence, whenever possible, these patients should be sent to reference centres where repair can be successfully achieved.
Coutinho et al. (Tue,) conducted a cohort in Failure of percutaneous mitral commissurotomy requiring surgery (n=61). Mitral valve repair vs. Mitral valve replacement was evaluated on Overall survival and freedom from reoperation. Mitral valve repair after failed percutaneous mitral commissurotomy was achieved in 62.3% of patients, yielding 82.7% 20-year survival and fewer valve-related events than replacement.