Document Detail

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.
MedLine Citation:
PMID:  22456478     Owner:  NLM     Status:  Publisher    
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.
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:
Type:  JOURNAL ARTICLE     Date:  2012-3-28
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 AP-HP, Bichat University Hospital, Paris, France;
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