Surgical rheumatic mitral valve repair compared with percutaneous balloon mitral valvuloplasty in mitral stenosis in current era: a propensity score matching study

Abstract

Background: Many comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with "four-step" procedure in the treatment of rheumatic MS. Methods: Patients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences. Results: A total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP.Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm 2 , P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively.Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent reintervention in rMVP, but one patient died of pneumonia. Conclusions: For selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with "four-step" procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).

Advances in valve repair for rheumatic mitral stenosis

“…Both diastolic and systolic parameters as well as coaptation depth are measured for acceptability, prediction of success, and durability of the repair. The feasibility and results of valve repair for rheumatic mitral stenosis have improved recently 9 , 19 , 20 ; however, certain limitations exist. In patients with severe valve pathology and calcification, and in elderly patients with comorbidity, mitral valve replacement is still a viable choice.…”

“…The feasibility and results of valve repair for rheumatic mitral stenosis have improved recently 9 , 19 , 20 ; however, certain limitations exist. In patients with severe valve pathology and calcification, and in elderly patients with comorbidity, mitral valve replacement is still a viable choice.…”

Valvulopatía reumática: principios, fisiopatología y tratamiento

“…Aunque se individualice cada caso, el tratamiento sigue siendo controversial. Este artículo discute los resultados de estudios que demuestran los pros y contras del tratamiento tanto endovascular como quirúrgico (3). Mediante los avances tecnológicos en los últimos años, el pronóstico, tanto a corto como a largo plazo, ha mejorado considerablemente (4).…”