Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Cardiology Department, Clinical Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Zand St., Cardiology Office, Shiraz, Iran.
BMC Cardiovasc Disord. 2021 Jul 28;21(1):355. doi: 10.1186/s12872-021-02175-3.
Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success.
In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm and loss of ≥ 50% of initial area gain.
During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm (p = 0.001, OR = 0.240).
The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).
风湿性心脏病（RHD）在发展中国家仍是一个令人关注的问题。在延迟出现的 RHD 中，风湿性二尖瓣狭窄（MS）仍然是一个常见的发现。经皮经腔二尖瓣球囊分离术（PTMC）是治疗严重二尖瓣狭窄（MS）的首选介入治疗方法。我们旨在评估即刻成功的 PTMC 患者的中期结果。
在这项回顾性队列研究中，在 2006 年至 2018 年间成功进行 PTMC 的 220 名患者中，186 名患者的临床过程可以成功随访。心脏相关死亡、接受第二次 PTMC 或二尖瓣置换术（MVR）被认为是本研究的不良心脏事件。为了找到与不良心脏结局相关的显著因素，收集了研究患者的围手术期数据。还联系了患者以了解他们的当前临床状况以及他们是否继续接受二级抗生素预防方案。那些没有遭受不良心脏事件的患者还被要求接受超声心动图检查，以评估二尖瓣瓣口面积（MVA）<1.5cm 和初始面积增加损失≥50%的二尖瓣再狭窄的发生率。
在平均 5.69±3.24 年的随访期间，31 名患者（16.6%的患者）发生了不良心脏事件。心房颤动节律（p=0.003，HR=3.659）、Wilkins 超声心动图评分>8（p=0.028，HR=2.320）和较高的术前收缩性肺动脉压（p=0.021，HR=1.031）是三个独立的不良事件预测因子，即刻 PTMC 后二尖瓣瓣口面积（IMVA）≥2cm（p<0.001，HR=0.06）是无事件生存的显著预测因子。此外，随访超声心动图检查发现 44 名患者（所有患者的 23.6%）存在二尖瓣再狭窄。唯一具有统计学意义的再狭窄保护因素仍然是 IMVA≥2cm（p=0.001，OR=0.240）。
PTMC 的中期结果是多因素的，可能受异质围手术期因素的影响。IMVA 对该手术的长期成功有很大影响。在本研究中，继续二级抗生素预防并不是预防不良心脏事件的保护因素。（临床试验注册：NCT04112108）。
