Abstract：
BACKGROUND: Percutaneous mitral balloon commissurotomy (PMBC) is the standard treatment option for patients with rheumatic mitral stenosis (MS), according to current guidelines. This study aimed to compare the outcomes of rheumatic mitral valve repair (rMVR) and PMBC in this patient population.
METHODS: Baseline, clinical, and follow-up data from 703 patients with rheumatic heart disease who underwent PMBC or rMVR at the current centre were collected and analysed. A 1:1 propensity score (PS) matching method was used to balance the differences in baseline characteristics between the two groups. The primary outcome was mitral valve reoperation, and the secondary outcome was all-cause mortality.
RESULTS: Propensity score matching generated 101 patient pairs for comparison. In the matched population, there were no significant differences in the early clinical outcomes between the groups. The median follow-up time was 40.9 months. Overall, patients in the rMVR group had a statistically significantly lower risk of mitral valve reoperation than those in the PMBC group (HR 0.186; 95% CI 0.041-0.835; p=0.028). Regarding all-cause mortality, no statistically significant differences were observed between the rMVR and PMBC groups (HR 4.065; 95% CI 0.454-36.374; p=0.210).
CONCLUSIONS: Compared with PMBC, rMVR has more advantages for the correction of valve lesions; therefore, it may offer a better prognosis than PMBC in select patients with rheumatic MS. However, this finding needs to be verified in future studies with larger sample sizes and longer follow-up periods.
METHODS: Baseline, clinical, and follow-up data from 703 patients with rheumatic heart disease who underwent PMBC or rMVR at the current centre were collected and analysed. A 1:1 propensity score (PS) matching method was used to balance the differences in baseline characteristics between the two groups. The primary outcome was mitral valve reoperation, and the secondary outcome was all-cause mortality.
RESULTS: Propensity score matching generated 101 patient pairs for comparison. In the matched population, there were no significant differences in the early clinical outcomes between the groups. The median follow-up time was 40.9 months. Overall, patients in the rMVR group had a statistically significantly lower risk of mitral valve reoperation than those in the PMBC group (HR 0.186; 95% CI 0.041-0.835; p=0.028). Regarding all-cause mortality, no statistically significant differences were observed between the rMVR and PMBC groups (HR 4.065; 95% CI 0.454-36.374; p=0.210).
CONCLUSIONS: Compared with PMBC, rMVR has more advantages for the correction of valve lesions; therefore, it may offer a better prognosis than PMBC in select patients with rheumatic MS. However, this finding needs to be verified in future studies with larger sample sizes and longer follow-up periods.
摘要：
背景：经皮二尖瓣球囊连缝切开术（PMBC）是风湿性二尖瓣狭窄（MS）患者的标准治疗选择，根据目前的指导方针。这项研究旨在比较风湿性二尖瓣修复（rMVR）和PMBC在该患者人群中的结果。
方法：基线，临床,收集并分析了在当前中心接受PMBC或rMVR的703例风湿性心脏病患者的随访数据。使用1：1倾向评分（PS）匹配方法来平衡两组之间基线特征的差异。主要结果是二尖瓣再次手术，次要结局是全因死亡率.
结果：倾向评分匹配产生101对患者进行比较。在匹配的人群中，两组早期临床结局无显著差异.中位随访时间为40.9个月。总的来说,rMVR组患者的二尖瓣再手术风险显著低于PMBC组(HR0.186;95%CI0.041-0.835;p=0.028).关于全因死亡率，rMVR组和PMBC组之间无统计学差异(HR4.065;95%CI0.454-36.374;p=0.210).
结论：与PMBC相比，rMVR对于瓣膜病变的矫正具有更多优势；因此，在某些风湿性MS患者中，它可能比PMBC提供更好的预后。然而,这一发现需要在未来样本量更大,随访时间更长的研究中得到验证.
方法：基线，临床,收集并分析了在当前中心接受PMBC或rMVR的703例风湿性心脏病患者的随访数据。使用1：1倾向评分（PS）匹配方法来平衡两组之间基线特征的差异。主要结果是二尖瓣再次手术，次要结局是全因死亡率.
结果：倾向评分匹配产生101对患者进行比较。在匹配的人群中，两组早期临床结局无显著差异.中位随访时间为40.9个月。总的来说,rMVR组患者的二尖瓣再手术风险显著低于PMBC组(HR0.186;95%CI0.041-0.835;p=0.028).关于全因死亡率，rMVR组和PMBC组之间无统计学差异(HR4.065;95%CI0.454-36.374;p=0.210).
结论：与PMBC相比，rMVR对于瓣膜病变的矫正具有更多优势；因此，在某些风湿性MS患者中，它可能比PMBC提供更好的预后。然而,这一发现需要在未来样本量更大,随访时间更长的研究中得到验证.
