Factors influencing immediate results, complications, and short-term follow-up status after inoue balloon mitral valvotomy: A North American multicenter study

Abstract

Clinical trials with the moue mitral valvotomy balloon have recently begun in the United States. We assessed the effects of 17 demographic, echocardiographic, procedural, and hemodynamic variables on the immediate results, complications, and short-term follow-up of 200 patients in 15 centers undergoing valvotomy with this device. The study population had a mean age + SD of 53 t-15 years, and the total echocardiographic score was 7.2 k 2.4. Valvotomy was technically successful in 96.5% of procedures and increased the mean mitral valve area from 1.0 + 0.3 to 1.6 t 0.7 cm2 (p < 0.001); 72% had an increase in valve area ?50%, and 67% had a final area ~1.5 cm'. Major procedural complications included cardiac tamponade during transseptal puncture (l.O%), systemic embolism (1.5%), and severe mitral regurgitation (2.4%); there were no procedural deaths and one hospital death. Multivariate analysis identified the absence of prior surgical commissurotomy and younger age as significant predictors of the gain in mitral valve area, but the correlation coefficients were low. Although the absence of subvalvular disease on echocardiograms was a predictor of a final valve area ~1.5 cm *, the total echocardiographic score did not correlate well with the immediate outcome (r = 0.01, p = NS). No variable was identified as predictive of festenosis, which occurred according to echocardiographic criteria in 14 of 66 (21%) patients evaluated 6 months after valvotomy. Good hemodynamic results with valvotomy were achieved in the majority of patients with low complication rates by many investigators with the use of the lnoue balloon device. In contrast to findings in previous studies that used other techniques, the immediate results with the lnoue procedure may be less influenced by age and echocardiographic valve morphology. (AM HEART J 1992;124:160.

Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

“…[5][6][7][8][9][10]12,15 Including poor immediate results leads to overestimation of the predictive value of valve anatomy on late results because valve anatomy is a strong predictor of procedural success. 21,22,34 A recent series including only good immediate results of PMC did not identify valve anatomy as a significant predictive factor of late functional results in multivariable analysis. 14 The interaction between rhythm and NYHA class shows that a higher initial NYHA class is a predictive factor of poor late functional results only in patients in atrial fibrillation.…”

Simplified percutaneous mitral valvuloplasty with the Inoue balloon

“…Clinical studies have demonstrated its immediate, short-and long-term efficacy [6][7][8][9][10] . It has also been successfully performed in children [11][12][13][14][15][16][17][18][19] and during pregnancy [20][21][22] . Acute mitral regurgitation remains the main complication of mitral valvuloplasty and the stepwise balloon dilatation [23,24] has not been demonstrated to decrease this problem.…”

“…Acute mitral regurgitation remains the main complication of mitral valvuloplasty and the stepwise balloon dilatation [23,24] has not been demonstrated to decrease this problem. Other complications, such as heart perforation, are rare [12] . Arterial complications are uncommon: vascular repair has been described in 0·1-1·0% of patients [25][26][27] , the need for blood transfusion in 0·01-0·5% [25,26,28] and the development of arteriovenous fistula in 0·01% of cases [6] .…”

Resultados imediatos e tardios da valvoplastia mitral percutânea em pacientes com estenose mitral

“…Hepatic insufficiency 1 Table 4 -Death causes during follow-up years [7][8][9][10][11][12][13][14][15][16][17][18] , however, the studied populations differ in their socioeconomic, ethnic, cultural and aging profiles, besides clinical and echocardiograph characteristics, from those found in our sample. All these particularities stick out the importance of knowing the long-term results of MVBC in the national context, which is represented by scarce but valuable studies 7,23 .…”

“…After the procedure, the immediate improvement of the valvar area and the survival without medium and long-term events [2][3][4] are comparable to the surgical commissurotomy 5,6 . Many factors have been suggested as determinants of late MVBC success, including: age, morphological aspects, cardiac rhythm, cardiac debt, mitral valve area (MVA) and experience of the intervention center [7][8][9][10][11][12][13][14][15][16][17][18] . However, there are still uncertainties with regard to these variables' predictive power, for the results are not homogeneous and some researchers did not found association of the abovementioned factors with long-term results 7,[9][10][11][12][13][14][15][16][17][18][19] .…”