January 16, 2025Open Access

Percutaneous Transvenous Mitral Commissurotomy for Patients with Rheumatic Heart Disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatic mitral stenosis (n=262). Intervention: Percutaneous transvenous mitral commissurotomy (PTMC). Primary outcome: Composite of all-cause death, repeated PTMC, and mitral valve surgery.

Key Result

Percutaneous transvenous mitral commissurotomy yielded a 10-year primary outcome-free survival rate of 67.2% in patients with rheumatic mitral stenosis, with postprocedural mitral valve orifice area and mitral regurgitation serving as independent prognostic predictors.

Study Design

Type

Cohort (n=262)

Multicenter

Structured PICO

Population

262 patients (mean age 50.1 years, 76% female) with rheumatic mitral stenosis who underwent percutaneous transvenous mitral commissurotomy, followed for a median of 69.5 months.

Exposure

Percutaneous transvenous mitral commissurotomy (PTMC) using the antegrade transvenous approach with the Inoue-balloon catheter system.

Outcome

Composite of all-cause death, repeated PTMC, and mitral valve surgery.composite

Percutaneous transvenous mitral commissurotomy provides favorable long-term outcomes for contemporary Chinese patients with rheumatic mitral stenosis, with preprocedural Emax, postprocedural MVOA, and postprocedural MR ≥ 2+ serving as independent prognostic factors.

Limitations

Observational retrospective design makes it challenging to accurately assess real contributions of predictors
Single-center data from a Chinese population limits extrapolation
Lack of long-term echocardiographic data on valvular conditions such as restenosis and calcification
9.9% of patients were lost to follow-up, potentially underestimating the cumulative incidence of the primary outcome

Abstract

Rheumatic heart disease remains common in developing countries. Current guidelines recommend percutaneous mitral commissurotomy (PTMC) as the preferred treatment for patients with rheumatic mitral stenosis (MS). This study reports the clinical outcomes of PTMC for rheumatic MS in contemporary Chinese patients and analyzes prognostic factors.Data from patients who underwent PTMC at our center between January 2007 and July 2023 were retrospectively analyzed. The primary outcome was the composite of all-cause death, repeated PTMC, and mitral valve surgery. Survival curve was constructed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify prognostic predictors, and hazards ratio (HRs) with 95% confidence intervals (CIs) were reported.A total of 262 patients with a mean age of 50.1 ± 14.1 years were included. The median follow-up time was 69.5 months. Kaplan-Meier analysis showed that primary outcome-free survival rate was 85.6% ± 2.5%, 67.2% ± 4.2%, and 55.2% ± 6.5% at 5, 10, and 15 years, respectively. In multivariate Cox regression analysis, preprocedural transmitral E peak velocity (Emax) (HR = 1.009, 95% CI: 1.002-1.016, P = 0.015), postprocedural mitral valve orifice area (MVOA) (HR = 0.284, 95% CI: 0.108-0.746, P = 0.011), and postprocedural mitral regurgitation (MR) ≥ 2+ (HR = 2.710, 95% CI: 1.382-5.314, P = 0.004) were identified as the independent predictors of the primary outcome.The clinical outcomes of PTMC are favorable for suitable patients with rheumatic MS. Meanwhile, preprocedural Emax, postprocedural MVOA, and postprocedural MR ≥ 2+ are the prognostic factors.

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