Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score?

Abstract

ObjectiveTo know the predictors of a successful outcome of percutaneous transvenous mitral commissurotomy (PTMC) other than described in the Wilkins scoring system.MethodsTwo hundred fifty-eight consecutive patients were enrolled for this observational study in a tertiary care heart center of Pakistan who had a Wilkins score of ≤8. Patients with more than mild mitral regurgitation (MR) or having a clot in the left atrium were excluded. The Bonhoeffer multi-track system was used as a default technique. Successful PTMC was defined as achieving a mitral valve area (MVA) of ≥1.5 cm2 with no more than mild MR.ResultsOut of 258 PTMC procedures, 197 were successful. The Bonhoeffer multi-track system was used in ~94% cases. Among unsuccessful procedures, 41 patients did not achieve the required valve area, and 21 patients developed more than mild MR, including those 8 patients who did not achieve the required valve area and had more than mild MR. Bigger mean annulus size (33.5±2.6 versus 32.8±2.1 mm; p=0.02) and pre-procedure MVA (0.93±0.1 versus 0.87±0.1 cm2; p=0.002) had a significant effect on successful PTMC. Lower mean preprocedure systolic right ventricular pressure on echo (65.4±19.4 versus 75.3±18 mm Hg; p=0.000) and on cath (74±21.5 versus 81.5±24.6 mm Hg; p=0.002), lower grade of left ventricular dysfunction (p=0.04), and tricuspid regurgitation on echo (p=0.003) also had positive effects on the outcome.ConclusionBigger preprocedure mitral valve annulus size and mitral valve area, and better left and right ventricular hemodynamics are correlated with successful PTMC.

Percutaneous mitral balloon valvuloplasty - state of the art

“…The double-balloon technique [ Figure 5] is effective but demanding and carries the risk of left ventricular perforation by the guidewires or the tip of the balloons [1,5,6,8,10] . The multi-track system [ Figure 6] is a variant of the double-balloon technique and aims to make the procedure easier through the use of a monorail balloon and only a single guidewire [36] . The Inoue technique [ Figure 7] has become the most popular technique worldwide [4,16,18,22,37] .…”

“…After complete deflation, the balloons are removed sequentially. The Multi-track system [ Figure 6] introduced by Bonhoeffer, shares the advantages of the traditional double-balloon technique [36] . It is safer and reduces the risk of accidental balloon displacement.…”

“…Subsequently, a rapid exchange balloon catheter running on the same guidewire is inserted and lined up with the first catheter so the two are positioned side by side. Both balloons are then inflated simultaneously [36] .…”

Right ventricular dyssynchrony and functional capacity before and after percutaneous balloon mitral valvuloplasty in patients with mitral stenosis: Determinants and clinical impact

“…10 An optimal PBMV results were defined as MVA ≥1.5 cm 2 with less than grade II mitral regurgitation, while the suboptimal results were defined as MVA <1.5 cm 2 . 10 An optimal PBMV results were defined as MVA ≥1.5 cm 2 with less than grade II mitral regurgitation, while the suboptimal results were defined as MVA <1.5 cm 2 .…”

“…All patients underwent PBMV by the antegrade trans-septal approach utilizing the Multi-track balloons with a stepwise dilatation strategy. 10 An optimal PBMV results were defined as MVA ≥1.5 cm 2 with less than grade II mitral regurgitation, while the suboptimal results were defined as MVA <1.5 cm 2 . 11…”