Percutaneous mitral commissurotomy for restenosis after surgical commissurotomy - Late efficacy and implications for patient selection

OBJECTIVES The results of percutaneous mitral commissurotomy were assessed in patients with restenosis after surgical commissurotomy. BACKGROUND Balloon dilation is feasible in patients with restenosis after s urgical commissurotomy, but little is known about its late efficacy. METHODS We studied 232 patients who had undergone percutaneous mitral commi ssurotomy a mean of 16 +/- 8 years after surgical commissurotomy. Mean age was 47 +/- 14 years; 81 patients (35%) had valve calcification. ALL patient s had restenosis with bilateral commissural fusion as assessed by echocardi ography. Technical failure occurred in 9 patients and the procedure used a single balloon in 7 patients, a double balloon in 95, and the Inoue balloon in 121. RESULTS Complications were death in 1 patient (0.4%) and mitral regurgitati on >2/4 in 10 (4%); 191 patients (82%) had good immediate results (valve ar ea greater than or equal to 1.5 cm(2) without regurgitation >2/4). Predicto rs of poor immediate results in multivariate analysis were older age (p < 0 .001), lower initial valve area (p = 0.01) and the use of the double-balloo n technique (p = 0.015). In the 175 patients who underwent follow-up, 8-yea r survival without operation and in New York Heart Association class I or I I was 48 +/- 5%, and 58 +/- 6% after good immediate results. Tn this latter group, poor late functional results were predicted by higher cardiothoraci c index (p < 0.0001), previous open-heart commissurotomy (p = 0.05) and low er final valve area (p ( 0.0001) in a multivariate Cox model. CONCLUSIONS Percutaneous mitral commissurotomy is safe and provides good im mediate results in selected patients with restenosis after surgical commiss urotomy. After good immediate results, the conditions of more than half of the patients remained improved at 8 years, enabling reoperation to be defer red. (J Am Coil Cardiol 2000;35:1295-1302) (C) 2000 by the American College of Cardiology.