Record number :
595824
Title of article :
Percutaneous mitral commissurotomy for restenosis after surgical commissurotomy: Late efficacy and implications for patient selection
Author/Authors :
Bernard Iung، نويسنده , , Eric Garbarz، نويسنده , , Pierre Michaud، نويسنده , , Abdallah Mahdhaoui، نويسنده , , Steeven Helou، نويسنده , , Bruno Farah، نويسنده , , Patricia Berdah، نويسنده , , Pierre-Louis Michel، نويسنده , , Yasuhiro Makita، نويسنده , , Bertrand Cormier، نويسنده , , Philippe Luxereau، نويسنده , , Alec Vahanian، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2000
Pages :
8
From page :
1295
To page :
1302
Abstract :
OBJECTIVES The results of percutaneous mitral commissurotomy were assessed in patients with restenosis after surgical commissurotomy. BACKGROUND Balloon dilation is feasible in patients with restenosis after surgical commissurotomy, but little is known about its late efficacy. METHODS We studied 232 patients who had undergone percutaneous mitral commissurotomy a mean of 16 ± 8 years after surgical commissurotomy. Mean age was 47 ± 14 years; 81 patients (35%) had valve calcification. All patients had restenosis with bilateral commissural fusion as assessed by echocardiography. Technical failure occurred in 9 patients and the procedure used a single balloon in 7 patients, a double balloon in 95, and the Inoue balloon in 121. RESULTS Complications were death in 1 patient (0.4%) and mitral regurgitation >2/4 in 10 (4%); 191 patients (82%) had good immediate results (valve area ≥1.5 cm2 without regurgitation >2/4). Predictors of poor immediate results in multivariate analysis were older age (p < 0.001), lower initial valve area (p = 0.01) and the use of the double-balloon technique (p = 0.015). In the 175 patients who underwent follow-up, 8-year survival without operation and in New York Heart Association class I or II was 48 ± 5%, and 58 ± 6% after good immediate results. In this latter group, poor late functional results were predicted by higher cardiothoracic index (p < 0.0001), previous open-heart commissurotomy (p = 0.05) and lower final valve area (p < 0.0001) in a multivariate Cox model. CONCLUSIONS Percutaneous mitral commissurotomy is safe and provides good immediate results in selected patients with restenosis after surgical commissurotomy. After good immediate results, the conditions of more than half of the patients remained improved at 8 years, enabling reoperation to be deferred.
Keywords :
CHC , closed-heart commissurotomy , EBDA , NYHA , OHC , effective balloon dilating area , open-heart commissurotomy , New York Heart Association , percutaneous mitral commissurotomy , PMC
Journal title :
JACC (Journal of the American College of Cardiology)
Serial Year :
2000
Link To Document :
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