Long-term outcomes of severe rheumatic mitral stenosis after undergoing percutaneous mitral commissurotomy and mitral valve replacement: a 10-year experience

Abstract

Introduction: Percutaneous mitral commissurotomy (PTMC) and mitral valve replacement(MVR) are treatments of choice for severe rheumatic mitral stenosis (MS). Data regarding the long-term outcomes of patients who underwent PTMC and MVR are limited. Methods: A retrospective cohort study was conducted to evaluate the long-term outcomes of patients with severe rheumatic MS who underwent PTMC or MVR between 2010 to 2020.The primary outcome comprised of all-cause death, stroke or systemic embolism, heart failure hospitalization and re-intervention. Cox regression was used to investigate predictors of the primary outcome. Results: 264 patients were included in analysis, 164 patients (62.1%) in PTMC group and 100patients in MVR group (37.9%). The majority were females (80.7%) and had atrial fibrillation(68.6%). The mean age was 49.52 (SD: 13.03) years old. MVR group had more age and AF,higher Wilkins’ score with smaller MVA. Primary outcome occurred significantly higher in PTMC group (37.2% vs 22%, p = 0.002), as well as, re-intervention (18.3% vs 0%, p 50 mmHg(HR 2.99; 95%CI 1.01, 8.84; p = 0.047) were the only predictors of primary outcome. Conclusion: Primary outcome occurred in PTMC group more than MVR group which was driven by re-intervention. However, all-cause mortality, stroke or systemic embolism and heart failure hospitalization were not significantly different.

Keywords

• long-term outcome
• mitral valve replacement
• percutaneous mitral commissurotomy
• rheumatic mitral stenosis