Department of Cardiac Surgery Center, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vascular Diseases, Capital Medical University, Beijing, China.
Department of Cardiac Surgery Center, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vascular Diseases, Capital Medical University, Beijing, China.
Heart Lung Circ. 2024 Oct;33(10):1450-1456. doi: 10.1016/j.hlc.2024.05.005. Epub 2024 Jul 2.
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.
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.
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).
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.
根据现行指南，经皮二尖瓣球囊分离术（PMBC）是风湿性二尖瓣狭窄（MS）患者的标准治疗选择。本研究旨在比较该患者人群中风湿性二尖瓣修复术（rMVR）和 PMBC 的结果。
收集并分析了当前中心 703 例风湿性心脏病患者行 PMBC 或 rMVR 的基线、临床和随访数据。采用 1:1 倾向评分（PS）匹配方法平衡两组间基线特征的差异。主要结局是二尖瓣再手术，次要结局是全因死亡率。
倾向评分匹配生成了 101 对患者进行比较。在匹配人群中，两组的早期临床结局无显著差异。中位随访时间为 40.9 个月。总体而言，rMVR 组患者二尖瓣再手术的风险明显低于 PMBC 组（HR 0.186；95%CI 0.041-0.835；p=0.028）。关于全因死亡率，rMVR 组和 PMBC 组之间无统计学显著差异（HR 4.065；95%CI 0.454-36.374；p=0.210）。
与 PMBC 相比，rMVR 在矫正瓣膜病变方面具有更多优势；因此，在选择的风湿性 MS 患者中，它可能比 PMBC 提供更好的预后。然而，这一发现需要在未来具有更大样本量和更长随访期的研究中得到验证。
