Abstract 14880: Optimizing Percutaneous Mitral Valvuloplasty for Rheumatic Mitral Stenosis: Clinical Significance of Mitral Valve Area Changes

Abstract

Introduction: Percutaneous mitral valvuloplasty (PMV) is an established treatment for severe rheumatic mitral stenosis (RMS). However, there is limited data on the clinical significance of mitral valve area change (ΔMVA) during PMV on prognosis. Hypothesis: The prognosis improves with greater post-procedure ΔMVA. Methods: Data from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, which included 3,140 patients with at least moderate RMS were analyzed. Out of those, patients with severe RMS (MVA < 1.5 cm 2 ) who underwent their first PMV were included for analysis. Changes in echocardiographic parameters before and after PMV were calculated, and composite outcomes including all-cause death, heart failure admission, stroke, and mitral valve re-intervention were evaluated. Results: A total of 295 patients were included, and during the median follow-up of 91.1 months, composite outcomes occurred in 76 patients (16.5% in optimal and ΔMVA > 0.5 cm2 group vs. 27.7% in optimal but ΔMVA ≤ 0.5 cm2 group vs. 35.7% in suboptimal group, respectively). Patients who achieved optimal results with ΔMVA > 0.5 cm 2 had a better prognosis compared to other groups. (log-rank p=0.002). The group with optimal result but ΔMVA ≤ 0.5 cm2 had a higher risk for composite outcomes compared to the group with ΔMVA > 0.5 cm2 (Hazard’s Ratio: 2.29, 95% confidence interval: 1.11-4.72, p=0.024). Conclusions: Achieving a significant increase in ΔMVA of at least 0.5 cm 2 can improve prognosis, and this could be recommended as an additional objective during PMV, in addition to the traditional optimal targets.