Meneveau N, Schiele F, Seronde M F, Breton V, Gupta S, Bernard Y, Bassand J P
Service de Cardiologie, Hôpital Universitaire Saint-Jacques, Besancon, France.
Heart. 1998 Oct;80(4):359-64. doi: 10.1136/hrt.80.4.359.
To assess the long term functional result after percutaneous mitral commissurotomy and identify the predictors of event-free survival following 10 years of experience.
Analysis of clinical, echocardiographic, and haemodynamic variables at baseline and after the procedure by univariate and multivariate analyses (Cox model).
University hospital.
532 consecutive patients receiving percutaneous mitral commissurotomy in the same institution.
The mean (SD) follow up was 3.8 (4.0) years. Survival at 3, 5, and 7.5 years was 94%, 91%, and 83%, respectively; event-free survival was 84%, 74%, and 52%. Mitral valve anatomy was identified as the strongest independent predictor of event-free survival. Age, cardiothoracic ratio, mean pulmonary artery pressure, and mean echocardiographic mitral gradient after commissurotomy were also found to be independent predictors of long term functional results. Event-free survival was 92%, 84%, and 70% at 3, 5, and 7.5 years in patients with favourable anatomy (echo score = 1), 86%, 73%, and 34% in patients with intermediate anatomy (echo score = 2), and 45%, 25%, and 16% in patients with unfavourable anatomy (echo score = 3). In patients aged < or = 65 years, the event-free survival rate was 80%, 70%, and 45% at 3, 5, and 7.5 years v 52%, 38%, and 17% in patients aged > 65 years.
The anatomical form of the mitral valve and the patient's age were the most powerful predictors of event-free survival. Patients with intermediate or unfavourable anatomy and those aged > 65 years have low 5 and 7.5 year event-free survival rates. This must be taken into account when discussing the indications for percutaneous mitral commissurotomy; immediate mitral valve replacement is a reasonable alternative to balloon mitral commissurotomy in patients with higher risk of functional deterioration after the procedure.
评估经皮二尖瓣交界切开术后的长期功能结果，并在积累了10年经验后确定无事件生存率的预测因素。
通过单变量和多变量分析（Cox模型）对基线及术后的临床、超声心动图和血流动力学变量进行分析。
大学医院。
在同一机构接受经皮二尖瓣交界切开术的532例连续患者。
平均（标准差）随访时间为3.8（4.0）年。3年、5年和7.5年的生存率分别为94%、91%和83%；无事件生存率分别为84%、74%和52%。二尖瓣解剖结构被确定为无事件生存率最强的独立预测因素。还发现年龄、心胸比率、平均肺动脉压和交界切开术后平均超声心动图二尖瓣压差是长期功能结果的独立预测因素。解剖结构良好（超声评分=1）的患者3年、5年和7.5年的无事件生存率分别为92%、84%和70%，解剖结构中等（超声评分=2）的患者分别为86%、73%和34%，解剖结构不佳（超声评分=3）的患者分别为45%、25%和16%。年龄≤65岁的患者3年、5年和7.5年的无事件生存率分别为80%、70%和45%，而年龄>65岁的患者分别为52%、38%和17%。
二尖瓣的解剖形态和患者年龄是无事件生存率最有力的预测因素。解剖结构中等或不佳以及年龄>65岁的患者5年和7.5年的无事件生存率较低。在讨论经皮二尖瓣交界切开术的适应证时必须考虑到这一点；对于术后功能恶化风险较高的患者，立即进行二尖瓣置换术是球囊二尖瓣交界切开术的合理替代方案。
