PREDICTORS OF LONG-TERM EVENT-FREE SURVIVAL AFTER PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Previous Studies have shown that long-term event-free survival after p ercutaneous balloon mitral valvuloplasty (PBMV) could be predicted by several baseline characteristics. However, the extent of the predictiv e variables has not been defined accurately yet. In this study, 40 bas eline demographic, clinical, echocardiographic, and hemodynamic variab les of 128 consecutive patients with mitral stenosis who underwent PBM V in a single institution, were analyzed in order to predict long-term event-free survival, defined as absence of death, mitral valve replac ement, or repeat PBMV. Univariate survival analysis showed that age (p = 0.03), history of commissurotomy or mitral valvuloplasty (p = 0.05) , calicum grade (p = 0.008), echo score (p = 0.0001), preprocedure car diac output (p = 0.03), preprocedure valve area (p = 0.0007), postproc edure mean left atrial pressure (p = 0.0001), postprocedure valve area (p = 0.0001), postprocedure valve gradient (p = 0.013), and postproce dural mitral regurgitation (p = 0.01) were statistically significant p redictors of event-free survival. Additionally, the absolute and/or re lative procedural change of the following variables were found to be s tatistically significant predictors of event-free survival: left atria l pressure (p = 0.01), valve area (p = 0.0001), and valve gradient (p = 0.02). Multivariate Cox proportional hazard analysis indicated that when only variables available before the procedure were considered, ec ho score (p = 0.002) and preprocedure valve area (p = 0.0002) were fou nd to be independent predictors of event-free survival. When both pre- and postprocedure variables were considered, echo score (p = 0.002) a nd postprocedure valve area (p = 0.0001) were found to be independent predictors of event-free survival. In conclusion, mitral valve morphol ogy reflected by echo score, and baseline and postprocedure mitral val ve area were found to be the strongest independent predictors of event -free survival after PBMV. (C) 1997 by Excerpta Medica, Inc.