Accomplishments and Perspectives with Retrograde Nontransseptal Balloon Mitral Valvuloplasty

Abstract

Retrograde nontransseptal balloon mitral valvuloplasty (RNBMV) is a transarterial technique of mitral valvuloplasty, developed with the aim to avoid complications associated with transseptal catheterization. Between April 1988 and December 1999, RNBMV has been attempted in 393 patients with symptomatic mitral stenosis (aged 44 ± 11 years, 322 women, mean echocardiographic score 7.7 ± 1.9) at the University of Athens, Greece. The procedure was completed in 392 cases. Technical success (gain in mitral valve area ≥ 50% with final mitral valve area ≥ 1.5 cm2, and absence of postprocedural mitral regurgitation grade > 2+) was achieved in 344 (87.5%) patients. Unfavorable predictors for immediate outcome included the echocardiographic score (P < 0.001). male gender (P = 0.005), and preprocedural mitral regurgitation (P = 0.003). Complications included death (0.3%), severe mitral regurgitation (3.1%), and femoral artery injury (0.8%). No cases of cardiac peqoration or tamponade have occurred with RNBMV. Patients with a successful immediate outcome were followed clinically for 4.8 ± 2.8 years (maximum 12 years). Event‐free (freedom from cardiac death, mitral valve replacement, redo valvuloplasty, and recurrence of NYHA Class > II) survival rates at 1, 2, 5, and 12 years post‐RNBMV were 99.7 ± 0.3%, 96.1 ± 1.1%, 84.7 ± 2.2%. and 67.6 ± 4.8%, respectively. The echocardiographic score (P < 0.001) and the postprocedural mitral valve area (P < 0.001) were significant independent predictors of long‐term outcome following RNBMV. Experience with RNBMV has fulfilled expectations regarding lowering of the risk of occurrence of specific cardiac complications encountered during mitral valvuloplasty, and reveals this approach as a safe and efficient alternative to the more commonly used antegrade technique.