The comparasion of early and long term follow up results of percutaneous mitral baloon valvuloplasty and mitral valve replacement

Introduction: The most common cause of mitral stenosis is rheumatic involvement. Despite its decreasing prevelance in the developed countries, it is one of the leading cause of the morbidity and mortality among the developing nations. The treatment of mitral stenosis consist three modalities, these are medical treatment, percutaneous mitral baloon valvuloplasty (PMBV) and mitral valve replacement(MVR). PMBV and MVR are the treatment options in mitral stenosis for several years, however studies that compare these two modalities are scarce. Aim: To compare the echocardiographic parameters and the result of early and late clinical follow up of patients after PMBV and MVR. Method: The clinical, echocardiographic and catheterization data of 527 patients with rheumathic mitral stenosis that are treated with PMBV or MVR are evaluated retrospectively (276 patients with PMBV and 251 patients with MVR). Pretreatment clinical (functional capacity, medical history, concomittant disase), echocardiographic parameters and long term follow up of the patients are obtained. The main end points in-hospital (early) and long term follow up are defined as death, need of early surgery, need of re-intervention, pericardial tamponade, embolic stroke and serious hemorrhage. Results: PMBV was performed to 276 and MVR was performed to 251 of the patients. The mean age of MVR patients was higher than PMBV patients(51.49 vs 40.88, p<0.001). Also there were higher percantage of male patients in MVR group(%23.1 vs. %11.6, p<0.001). After the intervention, the hospital stay of PMBV group was significantly shorter(2.02 days vs 10.62 days, p<0.001). The in hospital mortality of PMBV and MVR were %0 and %2 respectively. The success rate of PMBV was found to be %92.1, %7.8 needed surgical intervention in the hospital stay. The mean follow up time of PMBV group was 4.7 years and 5.45 years for MVR group (p=0.053). In the end of this period the mortality rates of PMBV and MVR were %0 and %4 respectively(p<0.001). The reintervention rate of PMBV group was %16.3 and it was %2.4 for the MVR group(p<0.001). Event free survival of PMBV after the follow up was %81 and in the MVR group it was %88(p=0.107). Conclusion: In our study, the event free survival of PMBV and MVR was found to be similar. The need of re-intervention was higher in PMBV group, however mortality rate of MVR was higher than PMBV. In conclusion, despite the fact that both modalities are used in the treatment of mitral stenosis, PMBV seems to be more advantageous taking into the consideration of low mortality rates, easy application of the procedure and lacking the need of general anesthesia.