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.