Outcomes of Patients With Mitral Stenosis With Prior Percutaneous Mitral Commissurotomy Undergoing Mitral Valve Surgery.

Limited data exist on outcomes for patients with mitral stenosis (MS) who have previously undergone percutaneous mitral commissurotomy (PMC) and later require surgical mitral valve replacement (MVR). This study evaluates the impact of prior PMC on clinical outcomes in rheumatic MS patients undergoing surgical MVR. We retrospectively compared rheumatic MS patients with and without a history of PMC who underwent surgical MVR between 2010 and 2020. The primary outcome was 5-year all-cause mortality, while secondary outcomes included mitral reintervention, rehospitalization for heart failure (HHF), stroke/transient ischemic attack (TIA), and major bleeding over 5 years. Among 1,137 patients with rheumatic MS undergoing surgical MVR, 77 (6.8%) had a history of prior PMC. Compared with patients without prior PMC, patients with prior PMC were more often female and presented with a lower baseline mitral valve pressure gradient. No significant difference in 5-year mortality was observed between patients with and without prior PMC (20.5% vs 17.6%; log-rank p = 0.614). Multivariate analysis confirmed no association between prior PMC and mortality risk (HR: 1.42; 95% CI: 0.82-2.46; p = 0.212). Secondary outcomes of HHF and major bleeding were not different between the 2 groups, although rates of mitral reintervention and stroke/TIA were higher in the prior PMC group (3.9% vs 0.8%; p = 0.014 and 5.2% vs 0.9%; p = 0.002, respectively). In conclusion, in patients with rheumatic MS undergoing surgical MVR, prior PMC did not increase long-term mortality, indicating its safety as an initial treatment. However, the increased risk of mitral reintervention and stroke/TIA suggests the need for long-term monitoring.