Reintervention after percutaneous mitral balloon commissurotomy in patients with rheumatic heart disease: feasibility of surgical mitral valve repair.

Background: Currently, mitral valve replacement is the primary method of reintervention for patients with rheumatic heart disease (RHD) after percutaneous mitral balloon commissurotomy (PMBC). This study aims to investigate the feasibility of mitral valve repair in such patients and report its therapeutic outcomes compared to mitral valve replacement. Methods: Data from patients with previous PMBC who underwent mitral valve surgery as disease progression between January 2011 and August 2023 were retrospectively analyzed. The patients were divided into two groups: the repair group and the replacement group. The stabilized inverse probability of treatment weighting (SIPTW) method was used to balance baseline characteristic differences between the two groups. Clinical outcomes investigated included freedom from mitral valve reoperation and overall survival. Survival curves were generated with the Kaplan-Meier (K-M) method, and differences between groups were compared using the Log-rank test. Results: A total of 210 patients were included in this study (32 in the repair group and 178 in the replacement group), with an average age of 56.6±10.0 years. After SIPTW, the baseline characteristics between the two groups were comparable. The median follow-up time for the entire cohort was 75.6 months. K-M analysis, adjusted for SIPTW, showed no significant differences between the two groups in terms of freedom from mitral valve reoperation and overall survival (Log-rank P=0.07 and 0.36, respectively). Conclusions: According to our results, even if patients with RHD have previously undergone PMBC, there is still a possibility of mitral valve repair in suitable patients, with good clinical outcomes.