0331: Predictors of outcome of repeated percutaneous mitral valvuloplasty

Abstract

Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy Compared with surgery, PMV is associated with shorter hospital stays, reduced patient discomfort, and significantly lower costs. However, it is unknown whether patients who developed symptomatic mitral restenosis after PMV may benefit from repeat PMV (re-PMV) with safety. This study was designed to evaluate the occurrence rate and the predictive factors for severe complications following re-PMV. Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon at 8±4 years after prior procedure, performed between 1996 and 2011. A clinical and ultrasound follow-up was achieved in 31 patients with a mean follow-up period of 43±26 months. The mean age of patients was 43±11 years [23, 63]. 87.5% of the population being female (5 men and 35 women). The immediate procedural success was achieved in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in 3 patients (7.5%). A cerebrovascular stroke occurred in 1 patient (2.5%). No procedure-related death or cardiac tamponade were noted. Only a left atrial area ≤25cm 2 was linked to high risk of severe MR. At long-term, mitral restenosis was observed in 13 patients (42%) at 53±30 months [9; 128] after re-PMV, 2 patients presented thromboembolic events (6%) and no death. Only the male had been identified as a predictor of restenosis. The feasibility of re – PMV with a relatively high procedural success rate and an acceptable complication profile makes it an appealing therapeutic strategy for patients with recurrent valve stenosis.