Systematic comparison of the effectiveness of percutaneous mitral balloon valvotomy with surgical mitral commissurotomy.

PRINCIPLES: Percutaneous mitral balloon valvotomy is increasingly being carried out on patients with pure mitral stenosis, but discrepant results are still available at long-term follow-ups following percutaneous balloon and traditional surgical valvotomy. This research sought to systematically compare the efficacy and safety of mitral balloon and surgical valvotomy.

METHODS: A systematic literature retrieval was performed for all clinical trials comparing the outcomes of mitral valvotomy with balloon intervention or surgery in Pubmed, EMBASE and the Cochrane Library.

RESULTS: A total of 12 eligible, clinical studies, comparing mitral valvotomy using percutaneous balloon intervention or thoracotomy surgery, were found between 1966 and 2010: seven prospective randomised trials and five case-control trials. With follow-up ranging from one to seven years, there was no significant difference in mortality (relative risk (RR) 0.97, 95% confidence interval (CI) 0.45-2.09) and complications (RR 2.15, 95% CI 0.98-4.7) between the two procedures. The pooling analysis obtained a significantly higher occurrence of new-onset mitral regurgitation after percutaneous balloon intervention relative to thoracotomy surgery (RR 1.66 95%CI 1.08-2.58). Similarly, we obtained a higher RR of re-intervention in balloon intervention compared to thoracotomy surgery of 2.88 (95% CI 1.97-4.2). In addition, compared to those patients who had thoracotomy surgery, patients who underwent percutaneous balloon intervention presented a significantly worse effect in preserving the mitral valve area: SMD -0.30, 95%CI: -0.42 - -0.18.

CONCLUSIONS: Clinical evidence suggests there are comparable clinical outcomes in terms of operative, late mortality and complications between percutaneous balloon and surgical mitral commissurotomy. Incidences of new-onset mitral regurgitation and late re-intervention are significantly higher after balloon intervention.