RESULTS 5 YEARS AFTER PERCUTANEOUS MITRAL COMMISSUROTOMY IN A SERIES OF 606 PATIENTS

The long-term results of percutaneous mitral commissurotomy were evalu ated in 606 patients with a mean age of 48 +/- 14 years. One hundred a nd eleven patients (48 %) had a history of surgical commissurotomy. At echocardiography, 91 patients (15 %) had flexible leaflets and little subvalvular apparatus, and 180 (30 %) have calcified valves. The proc edure was performed with a single balloon In 21 patients, a double bal loon in 402 patients and Inoue's balloon in 183 patients. A good immed iate, result, defined as a mitral valve surface area greater than or e qual to 1.5 cm(2) without > 2/4 mitral regurgitation, was obtained in 528 patients (87 %). Five hundred and eighty patients (96 %) were foll owed up for an average of 30 +/- 18 months. The actuarial 5 year rates were : survival 94 +/- 4 %; survival without surgery 74 +/- 6 %; surv ival without surgery with a good functional result (NYHA Classe I and II) 66 % +/- 6 %. Factors predictive of a good functional result were the valvular anatomy (p = 0.01), the NYHA Class before the procedure ( p = 0.02), the cardiothoracic ratio before the procedure (p = 0.005) a nd mitral valve surface area after the procedure (p = 0.007). The type of balloon had no influence on the result (p = 0.54). The authors con clude that the 5 year results of percutaneous mitral commissurotomy ar e good in a population of patients with varied characteristics. The pe rsistence of good functional results depends on anatomical and functio nal data and the quality of the initial result, but not an variables r elated to the procedure.