What are the intermediate-term survival and event-free survival rates, and their predictors, in patients with mitral stenosis undergoing catheter balloon commissurotomy?
Catheter balloon commissurotomy provides encouraging intermediate-term survival and event-free survival in selected patients with mitral stenosis, with post-procedure mitral valve area and pulmonary artery wedge pressure serving as strong predictors of long-term success.
BACKGROUND: The goal of the present study was to determine the intermediate-term survival and the independent predictors of survival and event-free survival for patients who undergo catheter balloon commissurotomy (CBC). METHODS AND RESULTS: CBC for the treatment of mitral stenosis was performed in 132 patients from 1986 through 1994. The use of CBC increased the mitral valve area (MVA) from 1.0 +/- 0.3 to 1.9 +/- 0.6 cm2 (P or = 1.5 versus 18 mm Hg (84 +/- 6% versus 38 +/- 11%) (P or = 1.5 cm2 (n = 96) could be further subdivided into high- and low-risk subgroups for 7-year event-free survival by two post-CBC variables: mean pulmonary artery wedge pressure of 18 mm Hg (90 +/- 6% versus 48 +/- 14%) (P = .0002) and cardiac index of > or = 2.5 versus < 2.5 L.min-1.m-2 (82 +/- 8% versus 61 +/- 13%) (P = .004). Patients with post-CBC MVA of < 1.5 cm2 (n = 24) had no additional predictors of event-free survival. Of patients who did not undergo MVR or repeat CBC, 8% were in New York Heart Association functional class III and 92% were in class I or early class II at the last follow-up. CONCLUSIONS: The rates for intermediate-term survival and event-free survival after CBC are very encouraging. Most patients without events were asymptomatic or minimally symptomatic. Thus, in selected patients with mitral stenosis who require an interventional procedure, CBC is the procedure of choice at centers with physicians who have experience and skill in performing this procedure.
Orrange et al. (Tue,) studied this question.