Acute results of percutaneous mitral balloon valvuloplasty

Abstract

We aimed to analyze acute clinical, echocardiographic, and hemodynamic results and long-term event-free survival of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of hemodynamically significant mitral stenosis (MS). We retrospectively reviewed 577 patients (454 females, 123 males; mean age 38±11 years) who underwent PMBV for moderate or severe MS. Acute procedural success was defined as the achievement of mitral valve area (MVA) >1.5 cm2 and absence of grade 3-4 mitral regurgitation. In addition, 489 patients were interrogated by phone calls for event-free survival (death, redo PMBV, mitral valve replacement) after at least one year (mean 54 months) of the procedure. The procedure was successful in 547 patients (94.8%) and unsuccessful in 30 patients (5.2%). Among baseline echocardiographic and hemodynamic parameters, MVA was significantly lower (p=0.0001) and moderate/severe tricuspid regurgitation was significantly more common (p=0.031) in patients with failure. The mean Wilkins scores were similar in the two groups (p>0.05). Failure was related to suboptimal valve opening (MVA <1.5 cm2) in 20 patients (66.7%), and grade 3-4 mitral regurgitation in 10 patients (33.3%). There were no in-hospital death, cardiac tamponade, or cerebrovascular accident. Acute complications included iatrogenic atrial septal defect (n=51, 8.8%) and groin hematoma (n=4, 0.7%). Inquiry for long-term outcomes showed that four patients had died, while 21 patients and six patients had undergone mitral valve replacement and redo PMBV, respectively. Our data suggest that PMBV is a safe and effective treatment option in MS and preprocedural MVA and tricuspid regurgitation are associated with acute failure of the procedure.