Actuarial Outcome After Catheter Balloon Commissurotomy in Patients With Mitral Stenosis

Abstract

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 cm 2 ( P <.001). There were six early deaths (4.5%) up to 1 month after CBC (“hospital” deaths). In the past 4.5 years, there have been no hospital deaths. Four late deaths occurred after elective mitral valve replacement (MVR). Actuarial 7-year survival was 95±1%; when mortality after MVR is included, 7-year survival was 83±6%. Actuarial 1-, 3-, 5-, and 7-year event-free survival (survival without MVR or repeat CBC) was 80±4%, 77±4%, 65±6%, and 65±6%. On multivariate analysis, the only two independent predictors (both after CBC) of 7-year event-free survival were MVA of ≥1.5 versus <1.5 cm 2 (75±7% versus 32±12%) and mean pulmonary artery wedge pressure of ≤18 versus >18 mm Hg (84±6% versus 38±11%) ( P <.001 for both). Patients with MVA of ≥1.5 cm 2 (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 versus >18 mm Hg (90±6% versus 48±14%) ( P =.0002) and cardiac index of ≥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 cm 2 (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.