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Outcomes with percutaneous mitral commissurotomy better in patients with non-calcified stenosis
Percutaneous mitral commissurotomy was associated with significantly better results at 20 years in patients with non-calcified vs. calcified mitral stenosis, according to recent findings.
The researchers aimed to evaluate long-term outcomes of percutaneous mitral commissurotomy (PMC) in calcific mitral stenosis to determine factors associated with late functional results. The analysis included 314 patients with calcific mitral stenosis and 710 patients with non-calcified valves.
The follow-up duration extended as long as 20 years. Clinicians used fluoroscopy to define calcification and graded it from 1 to 4.
Good results were defined as valve area ≥1.5 cm2 with mitral regurgitation ≤2/4. This outcome was reached by 80% patients with calcified valves and 93% of those in the non-calcified cohort (P<.001).
Good functional results were defined as survival without CV death or mitral regurgitation and in NYHA class I or II. At 20 years, compared with patients in the non-calcified group, those in the calcified valve group had a significantly higher HR for good functional results (HR=2.5; 12 ± 3% vs. 38 ± 2%; P<.0001).
Good immediate results occurred in 251 patients with calcified valves. Among those patients, 15-year good functional results demonstrated a 35 ± 4% rate of grade 1 calcification, 24 ± 6% for grade 2 and 10 ± 6% for grades 3 to 4.
Calcification extent, older age, higher NYHA class, atrial fibrillation and higher mean gradient after intervention were factors associated with poor late functional results, according to multivariable analysis.
“Although late results of PMC are less satisfying in calcific mitral stenosis, long-term functional outcome depends on calcification extent, patient characteristics and immediate results of PMC,” the researchers concluded. “These findings support the use of PMC as first-line treatment in selected patients with calcific mitral stenosis.”
Disclosure: The researchers report financial disclosures with Abbott, Boehringer Ingelheim, Edwards Lifesciences, Medtronic, Siemens and Valtech.