Clinical Outcomes After Valve Intervention in Rheumatic Mitral Valve Disease.

Abstract

Background: Rheumatic heart disease (RHD) remains one of the leading causes of mitral valve (MV) disease in developing countries. Despite the availability of percutaneous and surgical interventions, long-term outcomes remain unclear. This study aims to identify determinants of outcomes following percutaneous or surgical intervention in patients with rheumatic MV disease, addressing critical gaps in treatment selection.

Methods: A retrospective, intention-to-treat study was conducted on patients with symptomatic rheumatic MV disease, primarily characterized by mitral stenosis, who underwent either percutaneous mitral valvuloplasty (PMV) or MV replacement (MVR). Demographic, clinical, and echocardiographic variables were collected. The long-term outcome was defined as a composite of death, repeat PMV, need for cardiac surgery, and stroke.

Results: A total of 246 patients were enrolled (mean age 43.8 ± 13 years, 80% women, with 45% in New York Heart Association [NYHA] class III/IV). Of these, 90 patients (37%) underwent MVR, while 156 patients (63%) underwent PMV, with similar clinical characteristics at baseline. During a mean follow-up of 2.8 years, ranging from 1 day to 7.8 years, 45 patients (18%) reached the composite outcome, including 11 deaths (4%). Long-term outcomes were comparable between PMV and MVR (P = 0.231). Independent predictors of composite outcomes included baseline NYHA class III/IV (adjusted hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.10-4.11, P = 0.023) and older age (HR 1.03, 95% CI 1.01-1.06, p = 0.020). Predictors of all-cause mortality following either PMV or MVR were older age (HR 1.08, 95% CI 1.03-1.14, P = 0.002) and lower left ventricular ejection fraction (HR 0.93, 95% CI 0.88-0.99, P = 0.021).

Conclusions: This study identified older age and higher NYHA functional class as significant predictors of composite outcomes in patients with rheumatic MV disease requiring intervention. Left ventricular systolic dysfunction was independently associated with increased mortality following both percutaneous and surgical intervention. Long-term outcomes were comparable between patients undergoing PMV and MVR, reinforcing PMV as an effective alternative to surgery in appropriately selected patients.