Comparison of Mitral Valve Repair Versus Percutaneous Mitral Balloon Commissurotomy for Patients With Rheumatic Heart Disease: A Single-Centre Study - 02/07/24

Doi : 10.1016/j.hlc.2024.05.005

Xin Li, MD ^a, Yinfan Zhu, MD ^a, Jiajun Liang, MD ^a, Wenjian Jiang, MD ^a, Jie Han, MD ^a, Longfei Wang ^a,^⁎ , Yuyong Liu, MD ^b,^⁎ , Hongjia Zhang, MD ^a,^⁎
^a Department of Cardiac Surgery Center, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vascular Diseases, Capital Medical University, Beijing, China
^b Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China

^∗Corresponding author at: Department of Cardiac Surgery Center, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vascular Diseases, Capital Medical University, No. 2 Anzhen Road, Beijing, ChinaDepartment of Cardiac Surgery CenterBeijing Anzhen HospitalBeijing Institute of HeartCapital Medical UniversityNo. 2 Anzhen RoadBeijingChina^∗∗Corresponding author at: Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, ChinaDepartment of Cardiovascular SurgeryThe First Affiliated Hospital of Anhui Medical UniversityNo. 218 Jixi RoadHefeiChina^∗∗∗Corresponding author at: Department of Cardiac Surgery Center, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vascular Diseases, Capital Medical University, No. 2 Anzhen Road, Beijing, ChinaDepartment of Cardiac Surgery CenterBeijing Anzhen HospitalBeijing Institute of Heart, Lung, and Blood Vascular DiseasesCapital Medical UniversityNo. 2 Anzhen RoadBeijingChina

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 02 July 2024
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

Percutaneous mitral balloon commissurotomy (PMBC) is the standard treatment option for patients with rheumatic mitral stenosis (MS), according to current guidelines. This study aimed to compare the outcomes of rheumatic mitral valve repair (rMVR) and PMBC in this patient population.

Methods

Baseline, clinical, and follow-up data from 703 patients with rheumatic heart disease who underwent PMBC or rMVR at the current centre were collected and analysed. A 1:1 propensity score (PS) matching method was used to balance the differences in baseline characteristics between the two groups. The primary outcome was mitral valve reoperation, and the secondary outcome was all-cause mortality.

Results

Propensity score matching generated 101 patient pairs for comparison. In the matched population, there were no significant differences in the early clinical outcomes between the groups. The median follow-up time was 40.9 months. Overall, patients in the rMVR group had a statistically significantly lower risk of mitral valve reoperation than those in the PMBC group (HR 0.186; 95% CI 0.041–0.835; p=0.028). Regarding all-cause mortality, no statistically significant differences were observed between the rMVR and PMBC groups (HR 4.065; 95% CI 0.454–36.374; p=0.210).

Conclusions

Compared with PMBC, rMVR has more advantages for the correction of valve lesions; therefore, it may offer a better prognosis than PMBC in select patients with rheumatic MS. However, this finding needs to be verified in future studies with larger sample sizes and longer follow-up periods.

Le texte complet de cet article est disponible en PDF.

Keywords : Rheumatic heart disease, Mitral stenosis, Mitral valve repair, Percutaneous mitral balloon commissurotomy, Propensity score