Long-term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America

Abstract

Objective: To evaluate the long term clinical results of percutaneous mitral balloon valvuloplasty in patients with rheumatic mitral stenosis in Colombia, South America. Background: In 1993, Colombia, South America began a National Mitral Balloon Valvuloplasty Registry. This multicenter database was designed to establish the longterm safety and efficacy of percutaneous mitral valvuloplasty, as well as rate of restenosis. Methods: Between January 1993 and December 2011, 182 patients >18 years old were treated for rheumatic mitral stenosis with percutaneous valvuloplasty in two centers in Colombia, South America. Clinical, echocardiographic and hemodynamic data were stored in an electronic database. The Inoue Balloon technique was used in 99% of patients. The longest follow-up period was 15 years. Results: 182 patients were included; women (89%), hypertension (19%), dyslipidemia (1.6%), smoking (8.8%), diabetes (5.5%) and renal failure (1%). Forty-six patients (25.7%) were NYHA functional class III-IV. Procedure related mortality was 1.09% (2 patients). Fourteen patients (7.69%) had significant post procedure mitral insufficiency (grades III-IV); 4 patients (2.19%) had cardiac tamponade and 6 patients (3.3%) had vascular site related complications. The survival rate at 12 months was 96%. At 50 months, 60.7% of patients were alive and free of mitral surgery and repeated mitral valvuloplasty. The percentage of severe restenosis of mitral valve was 4.8%, 19.2%, 15.2% at one, five and 10 years of follow-up. Conclusions: Percutaneous mitral valvuloplasty using the Inoue balloon technique improves the hemodynamic profile of severe mitral stenosis. Long-term follow-up suggest that it is a safe alternative to mitral valve surgery in well selected patients.