Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

Abstract

Objectives: The study aim was to assess the long-term results (up to 18 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival. Methods: The immediate and long-term results for 531 consecutive patients (mean age 31 ± 11 years) who underwent successful MBV and were followed up for a mean of 8.5 ± 4.8 years (range: 1.5–18 years) are reported. Results: The mitral valve area (MVA) increased from 0.92 ± 0.17 to 1.95 ± 0.29 cm² (p < 0.0001). Restenosis was 31 and 19% in patients with mitral echocardiographic score (MES) ≤8. Actuarial freedom from restenosis at 10, 15 and 18 years was 77 ± 2, 46 ± 3 and 18 ± 4% and 86 ± 2, 62 ± 4 and 31 ± 7% for MES ≤8, respectively (p < 0.001). Event-free survival (death, redo MBV, mitral valve replacement, NYHA class III or IV) at 10, 15 and 18 years was 88 ± 1, 53 ± 4, and 21 ± 5% and 93 ± 2, 65 ± 5 and 38 ± 8% for MES ≤8, respectively (p < 0.001). Multivariable Cox regression analysis identified MES >8 (p < 0.0001) and previous surgery (p = 0.043) as predictors of restenosis, and MES >8 (p < 0.0001) and baseline atrial fibrillation (p = 0.03) as predictors of combined events. Conclusion: MBV provides excellent long-term results. The baseline clinical and MES characteristics are predictors of outcome.

Percutaneous Balloon Mitral Valvuloplasty

“…37,38 Randomized trials conducted in these young populations show that 3-and 7-year results of PBMV are as good as those obtained with open-heart commissurotomy 39 and better than those with closed-heart commissurotomy. 37 Fawzy et al 40,41 reported an event-free survival rate of 79% at 10 years and 43% at 15 years in relatively younger patients (mean age 31Ϯ11 years) and were significantly higher for patients with optimal valve anatomy (88% at 10 years, 66% at 15 years). They found that favorable valve anatomy, age, and postprocedural mitral valve area were predictors of event-free survival.…”

“…46 Reportedly, the freedom from restenosis rates were 85% at 5 years, 70% at 10 years, and 44% at 15 years and were significantly higher (ie, 92% at 5 years, 85% at 10 years, and 65% at 15 years) for patients with optimal morphology. 40,41 Repeat PBMV should be proposed as first-line therapy if patients had symptoms related to MS and showed only mild mitral regurgitation based on the observational evidence that the mechanism of mitral restenosis is primarily commissural refusion. 47 In patients with incomplete commissural fusion, repeat PBMV might end in suboptimal results.…”

Percutaneous Transmitral Commissurotomy (Ptmc); Procedural Success and Immediate Results, a Tertiary Care Hospital Experience From Developing Country

“…Re do balloon valvuloplasty or surgical mitral valve replacement are options for restenosis after PTMC. 18,26,27 CONCLUSION Percutaneous transmitral valvuloplasty is a safe and effective intervention for patients with severe MS and suitable valve in expert hand and even during special situations like pregnancy and re do cases.…”

An approach to the diagnosis and management of valvular heart disease

“…[3] This is also the treatment of choice for pregnant MS patients with pliable valves and poor response to medical therapy. Those with calcified, nonpliable valves or significant concomitant mitral regurgitation (MR) are referred for valve replacement surgery.…”