Ambari A M, Setianto B, Santoso A, Dwiputra B, Radi B, Alkatiri A A, Adji A B, Susilowati E, Tulrahmi F, Cramer M J M, Doevendans P A
Department of Cardiology Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia.
Department of Thorax Cardio Vascular Surgery, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia.
Neth Heart J. 2019 Nov;27(11):559-564. doi: 10.1007/s12471-019-01315-x.
Rheumatic mitral stenosis continues to be prevalent in developing countries, notably in endemic areas. Over the last few decades, percutaneous balloon mitral valvuloplasty (PBMV) has been established as a lower-cost alternative treatment for mitral stenosis (MS) in low-to-middle-income countries. PBMV has also been suggested to be an effective and safe alternative treatment modality. This study aims to analyse the survival of rheumatic MS patients treated with PBMV compared with those treated with mitral valve surgery (MVS).
This study was a national, single-centre, longitudinal study using a survival analysis method in 329 consecutive patients suffering from rheumatic heart disease with severe MS who underwent PBMV compared with 142 consecutive patients with similar characteristics who underwent MVS between January 2011 and December 2016. Survival analysis and event-free duration were determined over a median follow-up of 24 months in the PBMV group and 27 months in the MVS group.
The results showed that of the 329 consecutive patients in the PBMV group, 61 patients (18.5) had an event (6 patients died and 55 patients were hospitalised), and of the 142 consecutive patients in the MVS group, 19 patients (13.4%) had an event (5 patients died, and 14 patients were hospitalised). The hazard ratio was 0.631 (95% confidence interval, 0.376-1.058; P = 0.081). Longer short-term survival was found in the MVS group but was not statistically significant. Event-free survival was significantly longer in the MVS group (P = 0.002), by 5 months.
In this study, the efficacy and safety of PBMV was reconfirmed, as PBMV proved to be non-inferior to MVS in survival prognosis, but sustained event-free duration was significantly better in the MVS group than in the PBMV group.
风湿性二尖瓣狭窄在发展中国家，尤其是在流行地区仍然普遍存在。在过去几十年中，经皮球囊二尖瓣成形术（PBMV）已成为中低收入国家二尖瓣狭窄（MS）的一种低成本替代治疗方法。PBMV也被认为是一种有效且安全的替代治疗方式。本研究旨在分析接受PBMV治疗的风湿性MS患者与接受二尖瓣手术（MVS）治疗的患者的生存率。
本研究是一项全国性、单中心的纵向研究，采用生存分析方法，对2011年1月至2016年12月期间连续329例患有严重MS的风湿性心脏病患者进行PBMV治疗，并与142例具有相似特征的连续接受MVS治疗的患者进行比较。在PBMV组中，中位随访时间为24个月，在MVS组中为27个月，确定生存分析和无事件持续时间。
结果显示，在PBMV组的329例连续患者中，61例（18.5%）发生事件（6例死亡，55例住院），在MVS组的142例连续患者中，19例（13.4%）发生事件（5例死亡，14例住院）。风险比为0.631（95%置信区间，0.376-1.058；P = 0.081）。MVS组的短期生存率较长，但无统计学意义。MVS组的无事件生存率显著更长（P = 0.002），长5个月。
在本研究中，PBMV的疗效和安全性得到再次证实，因为PBMV在生存预后方面被证明不劣于MVS，但MVS组的持续无事件持续时间明显优于PBMV组。
