Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery

Song, Jae-Kwan; Kim, Mi-Jeong; Yun, Sung-Cheol; Choo, Suk Jung; Song, Jong-Min; Song, Hyun; Kang, Duk-Hyun; Chung, Cheol Hyun; Park, Duk Woo; Lee, Seung Whan; Kim, Young-Hak; Lee, Cheol Whan; Hong, Myeong-Ki; Kim, Jae-Joong; Lee, Jae Won; Park, Seong-Wook; Park, Seung-Jung

doi:10.1016/j.jtcvs.2009.04.022

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 1 , Pages 103-110, January 2010

Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery

Jae-Kwan Song, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Address for reprints: Jae-Kwan Song, MD, Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-ku, Seoul 138-736, South Korea.
Mi-Jeong Kim, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Sung-Cheol Yun, PhD
- Division of Biostatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Suk Jung Choo, MD
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Jong-Min Song, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Hyun Song, MD
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Duk-Hyun Kang, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Cheol Hyun Chung, MD
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Duk Woo Park, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Seung Whan Lee, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Young-Hak Kim, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Cheol Whan Lee, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Myeong-Ki Hong, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Jae-Joong Kim, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Jae Won Lee, MD
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Seong-Wook Park, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Seung-Jung Park, MD
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Received 30 January 2009; received in revised form 3 April 2009; accepted 23 April 2009. published online 06 July 2009.

Objectives

We sought to compare long-term outcomes between percutaneous mitral valvuloplasty and open heart surgery.

Methods

The study evaluated 402 patients who underwent percutaneous mitral valvuloplasty and 159 patients who underwent open heart surgery between January 1, 1995, and December 31, 2000. The rates of cardiovascular death or repeated intervention (redo percutaneous mitral valvuloplasty or open heart surgery) were determined over a median follow-up of 109 months (mean ± SD, 106 ± 27). The therapeutic effects on adverse outcomes were estimated by the Cox proportional hazards model adjusting differences in the severity of illness before intervention. The effects of the cardiac rhythm and echocardiographic score were also tested.

Results

The observed (unadjusted) event-free survival was similar for both groups, and the hazard ratio for the clinical events after percutaneous mitral valvuloplasty as compared with after open heart surgery was 1.510 (95% confidence interval, 0.914–2.496; P = .1079). However, the adjusted hazard ratio was 3.729 (95% confidence interval, 1.963–7.082; P < .0001), showing a higher event-free survival in the open heart surgery group. The adjusted hazard ratio after percutaneous mitral valvuloplasty as compared with after open heart surgery in patients with echocardiographic scores of 8 or more and atrial fibrillation were 5.348 (95% confidence interval, 2.504–11.422; P < .001) and 3.440 (95% confidence interval, 1.805–6.555; P = .0002), respectively, whereas the hazard ratio in patients with echocardiographic scores less than 8 and normal sinus rhythm did not show differences.

Conclusions

Open heart surgery was associated with a higher adjusted rate of long-term event-free survival than percutaneous mitral valvuloplasty. Patients with high echocardiographic scores or atrial fibrillation showed better outcomes after open heart surgery.

CTSNet classification: 35

Abbreviations and Acronyms: CI, confidence intervals, HR, hazard ratio, MS, mitral stenosis, MVR, mitral valve replacement, OHS, open heart surgery, OMC, open mitral commissurotomy, PMV, percutaneous mitral valvuloplasty