Late outcome of percutaneous mitral commissurotomy: randomized comparison of Inoue versus double-balloon technique

• Published in: The American heart journal 2017-12, Vol.194, p.1-8
• Main Authors: Lee, Sahmin, Kang, Duk-Hyun, Kim, Dae-Hee, Song, Jong-Min, Song, Jae-Kwan, Park, Seong-Wook, Park, Seung-Jung
• Format: Article
• Language: English
• Subjects: Adult; Balloon treatment; Balloon Valvuloplasty - instrumentation; Cardiac Catheterization - methods; Cardiac Surgical Procedures - methods; Cardiovascular; Catheters; Clinical outcomes; Confidence intervals; Data analysis; Disease-Free Survival; Echocardiography, Doppler; Equipment Design; Fatalities; Female; Follow-Up Studies; Forecasting; Heart; Humans; Male; Medical prognosis; Mitral valve; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Stenosis - diagnosis; Mitral Valve Stenosis - surgery; Multivariate analysis; Patients; Prospective Studies; Regurgitation; Severity of Illness Index; Stenosis; Studies; Surgery; Treatment Outcome
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2017.04.004

Background Late prognosis after successful percutaneous mitral commissurotomy (PMC) is unclear. We compared late results of PMC using Inoue versus double-balloon techniques up to 25 years in a randomized trial. Methods Between 1989 and 1995, 302 patients (77 men, 41 ± 11 years) with severe mitral stenosis were randomly assigned to undergo PMC using Inoue (n = 152; group I) or double-balloon technique (n = 150; group D). The end points were the composite events of death, mitral surgery, repeat PMC, or deterioration of New York Heart Association (NYHA) class ≥3. Results During median follow-up of 20.7 years (maximum, 25.6), clinical events occurred in 82 (53.9%) patients in group I (37 deaths, 44 mitral surgeries, 9 repeat PMCs, 3 NYHA class ≥3) and in 79 (52.7%) patients in group D (34 deaths, 51 mitral surgeries, 5 repeat PMCs, 4 NYHA class ≥3). Event-free survival rates at 24 years were not significantly different between group I and group D (40.8% and 42.6%, respectively; hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.65–1.20; P = .423). On multivariate analysis, absence of post-PMC commissural mitral regurgitation (MR) (HR, 1.84; 95% CI, 1.28–2.63; P = .001) and immediate post-PMC mitral valve area (MVA)