FUNCTIONAL RESULTS 5 YEARS AFTER SUCCESSFUL PERCUTANEOUS MITRAL COMMISSUROTOMY IN A SERIES OF 528 PATIENTS AND ANALYSIS OF PREDICTIVE FACTORS

Objectives. This study sought to assess late functional results after successful percutaneous mitral commissurotomy and to determine their p redictors. Background. Few studies have reported late results of percu taneous mitral commissurotomy or have analyzed their late results rega rdless of immediate results, despite the fact that late deterioration may well be related either to a decrease in valve area or to poor init ial results. Methods. Between 1986 and 1999, 528 patients underwent su ccessful percutaneous mitral commissurotomy (mean [ +/- SD] age 46 +/- 18 years; mean follow-up 32 +/- 18 months). A successful procedure wa s defined by a mitral valve area greater than or equal to 1.5 cm(2) an d no regurgitation >2/4. Dilation was performed using a single balloon in 13 patients, a double baboon in 349 and the Inoue balloon in 166. Multivariate analysis,vas performed with a Cox model. Results. The sur vival rate for patients in New York Heart Association functional class I or II, with no cardiac-related deaths or need for mitral surgery or repeat dilation, was 76 +/- 6% at 5 years. By multivariate analysis, the independent predictors of good functional results were echocardiog raphic group (p = 0.01), functional class (p = 0.02) and cardiothoraci c index (p = 0.005) before the procedure and valve area after the proc edure (p = 0.007). The predictive model derived allowed estimation of the probability of good functional results according to the value of t hese four predictors for any given patient. Conclusions. Good function al results were observed 5 years after successful percutaneous mitral commissurotomy in a large series of varied patients. The analysis of p redictive factors may provide useful indications for follow-up results in patients undergoing this technique.