0276: Balloon mitral valvotomy for patients with mitral stenosis in atrial fibrillation: immediate and long term prognosis

Abstract

Atrial fibrillation (AF) is a common finding in patients with severe mitral stenosis requiring Balloon Mitral Valvotomy (BMV). Its immediate and long term prognosis remains controversial. We sought to evaluate the effect of AF on the immediate and long-term (23 years) outcome of patients undergoing BMV. The immediate procedural and the long-term clinical outcome after BMV of 139 patients with AF were collected and compared with those of 381 patients in normal sinus rhythm (NSR). Patients with AF were older (43.3 vs. 29.7 years; p < 0.001), had frequently a history of systemic embolism (9.4% vs. 1.6%, p> 0.001) and of mitral commissurotomy (28.1% vs. 19.4%, p=0.035). Patients with AF had more frequently a Wilkins score > 8 (51.4% vs. 30.9%, p <0.001), a larger left atrium (41cm 2 vs. 32cm 2 , p= 0.001) and a lower transmitral gradient (11.1 mmHg vs. 16.6 mmHg, p < 0.001). BMV was equally successful in the two groups (90.6% vs. 94%, p=0.187) but resulted in a smaller post BMV area (2cm 2 vs. 2.15cm 2 , p=0.012) with a lower mitral valve area gain (0.9cm 2 vs. 1 C, p=0.015). BMV was not associated with a higher risk of complications (4.3% vs. 4.7%, p= 0.844). After a mean follow-up of 74 months, patients with AF had the same rate of restenosis (28.3% vs. 25.6%, p=0.96) but required more frequently a mitral valve replacement (16.3% vs. 7.7%, p= 0.012). They also experienced higher rates of systemic embolism (3.8% vs. 0.6%, p=0.018) and had a lower rate of event free survival (52.2% vs 68.8%, p= 0.047). In the group of patients in AF, predictive factors for combined adverse events including death, restenosis, and systemic embolism. Predictive factors of mitral valve replacement are: post BMV area < 2cm 2 (OR: 2.5, 95% CI [1.2; 5.18], p= 0.014), procedural complications including severe mitral regurgitation and tamponnade (OR: 3.95, p= 0.009) and NYHA ≥ II during follow up (OR: 3.46, p <0.001). Our data support the fact that patients with AF have worse immediate and long term outcomes after BMV. Post BMV area <2cm 2 , procedural complications and dyspnea predict adverse events during follow up.