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Long-term efficacy of percutaneous mitral commissurotomy for restenosis after previous mitral commissurotomy

Objective We analysed long-term results of percutaneous mitral commissurotomy (PMC) performed because of mitral restenosis after previous commissurotomy. Design Follow-up of a prospective cohort. Setting Tertiary university hospital. Patients We studied 163 consecutive patients who underwent PMC because of restenosis occurring 16±8 years after previous commissurotomy (closed-heart in 121, open-heart in 30 and PMC in 12). Mean age was 48±14 years; 62 patients (38%) had valve calcification. Restenosis was due to bicommissural fusion in all cases. Intervention PMC using a single or double balloon in 80 patients and the Inoue balloon in 83. Results Good immediate results (IR) (valve area ≥1.5 cm2 with MR≤2/4) were obtained in 135 pts (83%). 20-year rates were 27.9±4.7% for cardiovascular survival without mitral surgery and 14.8±3.9% for good functional results (cardiovascular survival without reintervention on the mitral valve and in New York Heart Association (NYHA) class I or II). After good IR, 20-year rates were 33.2±5.5% for cardiovascular survival without surgery and 17.9±4.7% for good functional results. After good IR, multivariate predictive factors of poor late functional results were higher NYHA class (p=0.01), atrial fibrillation (p=0.0002) and higher mean mitral gradient after PMC (p=0.004). Conclusions In patients with restenosis after mitral commissurotomy, PMC provides good IR in most cases. After good IR, one patient out of three remains free from surgery and one out of five has good functional results at 20 years. These findings support the use of PMC after previous commissurotomy, particularly in selected patients with few symptoms and in sinus rhythm.