Long-term outcomes and predictors of restenosis after percutaneous mitral commissurotomy: a 30-year single-center experience

Background

Percutaneous mitral commissurotomy (PMC) is an established treatment for rheumatic mitral stenosis. Although immediate success is well documented, long-term durability and factors associated with restenosis remain clinically relevant.

Purpose

To evaluate long-term efficacy and identify predictors of restenosis after PMC in a 30-year single-center cohort.

Methods

We retrospectively analyzed 130 patients who underwent PMC between 1989 and 2019. Clinical, echocardiographic, and hemodynamic parameters were assessed before and after the procedure. Procedural success was defined as post-PMC mitral valve area (MVA) ≥1.5 cm² without significant mitral regurgitation. Restenosis was defined as MVA <1.5 cm² during follow-up.

Results

PMC significantly increased MVA from 1.08 ± 0.24 cm² to 2.01 ± 0.33 cm² (p<0.001), with significant reductions in transmitral gradients and pulmonary pressures. Procedural success was achieved in approximately 80% of patients.

During a mean follow-up of 18.9 ± 8.6 years, restenosis occurred in 38% of cases.

Restenosis was significantly associated with Wilkins score >8, baseline mitral regurgitation, atrial fibrillation, and age >50 years. No significant association was observed with NYHA class or baseline pulmonary pressures.

Conclusion

PMC provides durable long-term clinical benefit in rheumatic mitral stenosis. Anatomical valve characteristics and rhythm disturbances are key determinants of restenosis. Careful pre-procedural evaluation remains essential to optimize long-term outcomes.