ACTUARIAL OUTCOME AFTER CATHETER BALLOON COMMISSUROTOMY IN PATIENTS WITH MITRAL-STENOSIS

Background The goal of the present study was to determine the intermed iate-term survival and the independent predictors of survival and even t-free survival for patients who undergo catheter balloon commissuroto my (CBC). Methods and Results CDC 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 hosp ital deaths. Four late deaths occurred after elective mitral valve rep lacement (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 greater than or equal to 1.5 versus <1.5 cm (2) (75+/-7% versus 32+/-12%) and mean pulmonary artery wedge pressure of less than or equal to 18 versus >18 mm Hg (84+/-6% versus 38+/-11% ) (P<.001 for both). Patients with MVA of greater than or equal to 1.5 cm(2) (n=96) could be further subdivided into high- and low-risk subg roups for 7-year event-free survival by two post-CBC variables: mean p ulmonary artery wedge pressure of less than or equal to 18 versus >18 mm Hg (90+/-6% versus 48+/-14%) (P=.0002) and cardiac index of greater than or equal to 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 n ot undergo MVR or repeat CBC, 8% were in New York Heart Association fu nctional class III and 92% were in class I or early class II at the la st follow-up. Conclusions The rates for intermediate-term survival and event-free survival after CBC are very encouraging. Most patients wit hout events were asymptomatic or minimally symptomatic. Thus, in selec ted patients with mitral stenosis who require an interventional proced ure, CBC is the procedure of choice at centers with physicians who hav e experience and skill in performing this procedure.