Iung B, Cormier B, Ducimetiere P, Porte J M, Nallet O, Michel P L, Acar J, Vahanian A
Cardiology Department, Tenon Hospital, Paris, France.
J Am Coll Cardiol. 1996 Feb;27(2):407-14. doi: 10.1016/0735-1097(95)00481-5.
This study sought to assess late functional results after successful percutaneous mitral commissurotomy and to determine their predictors.
Few studies have reported late results of percutaneous mitral commissurotomy or have analyzed their late results regardless of immediate results, despite the fact that late deterioration may well be related either to a decrease in valve area or to poor initial results.
Between 1986 and 1992, 528 patients underwent successful percutaneous mitral commissurotomy (mean [+/- SD] age 46 +/- 18 years; mean follow-up 32 +/- 18 months). A successful procedure was defined by a mitral valve area > or = 1.5 cm2 and no regurgitation > 2/4. Dilation was performed using a single balloon in 13 patients, a double balloon in 349 and the Inoue balloon in 166. Multivariate analysis was performed with a Cox model.
The survival rate for patients in New York Heart Association functional class I or II, with no cardiac-related deaths or need for mitral surgery or repeat dilation, was 76 +/- 6% at 5 years. By multivariate analysis, the independent predictors of good functional results were echocardiographic group (p = 0.01), functional class (p = 0.02) and cardiothoracic index (p = 0.005) before the procedure and valve area after the procedure (p = 0.007). The predictive model derived allowed estimation of the probability of good functional results according to the value of these four predictors for any given patient.
Good functional results were observed 5 years after successful percutaneous mitral commissurotomy in a large series of varied patients. The analysis of predictive factors may provide useful indications for follow-up results in patients undergoing this technique.
本研究旨在评估经皮球囊二尖瓣成形术成功后的远期功能结果，并确定其预测因素。
尽管远期病情恶化很可能与瓣膜面积减小或初始结果不佳有关，但很少有研究报道经皮球囊二尖瓣成形术的远期结果，或分析其远期结果而不考虑即刻结果。
1986年至1992年间，528例患者成功接受了经皮球囊二尖瓣成形术（平均[±标准差]年龄46±18岁；平均随访32±18个月）。成功的手术定义为二尖瓣瓣口面积≥1.5 cm²且反流不超过2/4级。13例患者使用单球囊进行扩张，349例使用双球囊，166例使用Inoue球囊。采用Cox模型进行多因素分析。
纽约心脏协会心功能I或II级、无心脏相关死亡、无需二尖瓣手术或再次扩张的患者5年生存率为76±6%。多因素分析显示，手术前超声心动图分组（p = 0.01）、心功能分级（p = 0.02）、心胸指数（p = 0.005）以及术后瓣膜面积（p = 0.007）是远期功能良好的独立预测因素。根据所推导的预测模型，可依据这四个预测因素的值估算任何给定患者远期功能良好的概率。
在一大组不同患者中，经皮球囊二尖瓣成形术成功后5年观察到良好的功能结果。对预测因素的分析可为接受该技术治疗的患者的随访结果提供有用的指导。
