Percutaneous Transvenous Mitral Commissurotomy for Patients with Rheumatic Heart Disease

Analysis of Clinical Outcomes and Prognostic Factors

抄録

Rheumatic heart disease remains common in developing countries. Current guidelines recommend percutaneous mitral commissurotomy (PTMC) as the preferred treatment for patients with rheumatic mitral stenosis (MS). This study reports the clinical outcomes of PTMC for rheumatic MS in contemporary Chinese patients and analyzes prognostic factors.

Data from patients who underwent PTMC at our center between January 2007 and July 2023 were retrospectively analyzed. The primary outcome was the composite of all-cause death, repeated PTMC, and mitral valve surgery. Survival curve was constructed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify prognostic predictors, and hazards ratio (HRs) with 95% confidence intervals (CIs) were reported.

A total of 262 patients with a mean age of 50.1 ± 14.1 years were included. The median follow-up time was 69.5 months. Kaplan-Meier analysis showed that primary outcome-free survival rate was 85.6% ± 2.5%, 67.2% ± 4.2%, and 55.2% ± 6.5% at 5, 10, and 15 years, respectively. In multivariate Cox regression analysis, preprocedural transmitral E peak velocity (Emax) (HR = 1.009, 95% CI: 1.002-1.016, P = 0.015), postprocedural mitral valve orifice area (MVOA) (HR = 0.284, 95% CI: 0.108-0.746, P = 0.011), and postprocedural mitral regurgitation (MR) ≥ 2+ (HR = 2.710, 95% CI: 1.382-5.314, P = 0.004) were identified as the independent predictors of the primary outcome.

The clinical outcomes of PTMC are favorable for suitable patients with rheumatic MS. Meanwhile, preprocedural Emax, postprocedural MVOA, and postprocedural MR ≥ 2+ are the prognostic factors.