long-term outcomes of severe rheumatic mitral stenosis after undergoing percutaneous mitral commissurotomy and mitral valve replacement: a 10-year experience

Introduction: percutaneous mitral commissurotomy (ptmc) and mitral valve replacement (mvr) are treatments of choice for severe rheumatic mitral stenosis (ms). data regarding the long-term outcomes of patients who underwent ptmc and mvr are limited. methods: a retrospective cohort study was conducted to evaluate the long-term outcomes of patients with severe rheumatic ms who underwent ptmc or mvr between 2010 to 2020. the primary outcome comprised of all-cause death, stroke or systemic embolism, heart failure hospitalization and re-intervention. cox regression was used to investigate predictors of the primary outcome. results: 264 patients were included in analysis, 164 patients (62.1%) in ptmc group and 100 patients in mvr group (37.9%). the majority were females (80.7%) and had atrial fibrillation (68.6%). the mean age was 49.52 (sd: 13.03) years old. mvr group had more age and af, higher wilkins’ score with smaller mva. primary outcome occurred significantly higher in ptmc group (37.2% vs 22%, p = 0.002), as well as, re-intervention (18.3% vs 0%, p < 0.001). however, all-cause mortality, stroke or systemic embolism and heart failure hospitalization were not significantly different. in multivariate cox regression analysis, ptmc (hr 1.94; 95%ci 1.14, 3.32; p = 0.015), older age (hr 1.03; 95%ci 1.01, 1.06; p = 0.009) and spap > 50 mmhg (hr 2.99; 95%ci 1.01, 8.84; p = 0.047) were the only predictors of primary outcome. conclusion: primary outcome occurred in ptmc group more than mvr group which was driven by re-intervention. however, all-cause mortality, stroke or systemic embolism and heart failure hospitalization were not significantly different.