What are the differences in presentation of candidates for percutaneous mitral commissurotomy across the world and do they influence the results of the procedure?

Abstract

Background: Despite marked global differences in the prevalence of rheumatic heart disease, little is known about geographic variations in the characteristics of patients with severe mitral stenosis.

Aim: To determine if differences in rheumatic fever epidemiology influence the characteristics of patients with mitral stenosis and the immediate results of percutaneous mitral commissurotomy (PMC).

Methods: We compared 350 patients (mean age: 41+/-17 years, 81% women) scheduled for PMC in five non-Western and two Western countries. Fifty consecutive patients were included in each centre. All presented a mitral valve area less than 1.5 cm2 and were in New York Heart Association (NYHA) functional class greater or equal to II, with no contraindications to PMC.

Results: The 250 patients from non-Western countries were younger than the 100 patients from Western countries (35+/-12 vs 57+/-15 years, p<0.0001) and had more severe valve disease, assessed by indexed valve area (0.57+/-0.14 vs 0.62+/-0.14 cm2/m2 body surface area, p=0.006), mean gradient (15+/-6 vs 8+/-4 mmHg, p<0.0001) and systolic pulmonary artery pressure (57+/-21 vs 42+/-14 mmHg, p<0.0001). PMC complication rates did not differ significantly. Good immediate PMC results were observed in 225 patients (90%) in non-Western and 88 (88%) in Western centres (p=0.58).

Conclusions: Compared with Western countries, PMC candidates from non-Western countries are younger, with more severe valve stenosis. However, PMC achieves good immediate results in a similarly high proportion of patients, showing the wide applicability of this technique.