Late results of percutaneous mitral commissurotomy in a series of 1024 patients - Analysis of late clinical deterioration: Frequency, anatomic findings, and predictive factors

Background-The optimal use of percutaneous mitral commissurotomy (PMC) in a wide range of patients requires accurate evaluation of late results and id entification of their predictors. Methods and Results-Late results of PMC were assessed in 1024 patients whos e mean age was 49+/-14 years. Echocardiography showed that 141 patients (14 %) had pliable valves and mild subvalvular disease, 569 (55%) had extensive subvalvular disease, and 314 (31%) had calcified valves. A single balloon was used in 26 patients, a double balloon in 390, and the Inoue Balloon in 608, Good immediate results were defined as valve area greater than or equa l to 1.5 cm? without regurgitation >2/4 (Sellers' grade) and were obtained in 912 patients. Median duration of follow-up was 49 months. The 10-year ac tuarial rate of good functional results (survival with no cardiovascular de ath and no need for surgery or repeat dilatation and in New York Heart Asso ciation [NYHA] class I or II) was 56+/-4% in the entire population. Follow- up echocardiography was available in 90% of the patients who experienced po or functional results after good immediate results and showed restenosis in 97% of these. In multivariate analysis, the predictors of poor functional results were old age (P=0.0008), unfavorable valve anatomy (P=0.003), high NYHA class (P<0.0001), atrial fibrillation (P<0.0001), low valve area after PMC (P=0.001), high gradient after PMC (P<0.0001), and grade 2 mitral regu rgitation after PMC (P=0.04). Conclusions-PMC can be performed with good late results in a variety of pat ient subsets. prediction of late events is multifactorial. Knowledge of the se predictors can improve patient selection and follow-up.