| Late Results of Percutaneous Mitral Commissurotomy up to 20 Years: Development and Validation of a Risk Score Predicting Late Functional Results from a Series of 912 Patients. | |
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MedLine Citation:
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PMID: 22456478 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Long-term follow-up after percutaneous mitral commissurotomy (PMC) enables predictive factors of late results to be identified. METHODS AND RESULTS: Late results of PMC were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5cm(2) without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients, used respectively to develop and validate a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery or repeat-PMC, and in NYHA class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient (p<0.0001), interaction between age and final mitral valve area (p<0.0001), showing that the impact of valve area decreases with age, interaction between sex and valve calcification (p<0.0001) showing that the impact of valve anatomy is stronger in men, interaction between rhythm and NYHA class showing an impact of NYHA class only in patients in atrial fibrillation (p<0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1% and 10.5% at 20 years in the validation cohort. CONCLUSIONS: Twenty years after PMC in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful to estimate individual patient outcome. |
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Authors:
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Claire Bouleti; Bernard Iung; Cédric Laouénan; Dominique Himbert; Eric Brochet; David Messika-Zeitoun; Delphine Détaint; Eric Garbarz; Bertrand Cormier; Pierre-Louis Michel; France Mentré; Alec Vahanian |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-3-28 |
Journal Detail:
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Title: Circulation Volume: - ISSN: 1524-4539 ISO Abbreviation: - Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-3-29 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 AP-HP, Bichat University Hospital, Paris, France; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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