Balloon mitral commissurotomy in patients aged ≥70 years

Abstract

Of 280 patients treated by balloon mitral commissurotomy (BMC) between 1987 and 1991, 28 (10%) were ≥70 years old. Two patients with associated significant aortic stenosis were excluded from the study. Older patients more often were in New York Heart Association class III or IV (84 vs 67%; p < 0.007) and atrial fibrillation (61 vs 36%; p < 0.0001), and had a higher echocardiographic score (9.3 ± 2 vs 8 ± 1.6; p < 0.0004) and a lower baseline cardiac index (2.1 ± 0.6 vs 2.4 ± 0.6 liters/min/m 2; p < 0.03) than younger ones. Baseline mean pulmonary pressure (37 ± 11 vs 34 ± 12 mm Hg), transmitral gradient (14 ± 4 vs 14 ± 5 mm Hg) and valve area (1.0 ± 0.4 vs 1.1 ± 0.3 cm 2) were not different between older and younger patients (p = NS). Acute complications during the procedure (including cardiac perforation, embolism, severe mitral regurgitation and surgical atrial shunt), and 30-day mortality after BMC were more frequent in older than younger patients (27 vs 9% [p < 0.01], and 12 vs 0.8% [p < 0.005], respectively). A complete success, defined as a mitral valve area increase >25% and postmitral valve area >1.5 cm 2 was obtained in 16 of the 22 older patients (72%) with the completed procedure (compared with 81% of younger ones; p = 0.1). At 6 months, 20 of the 21 surviving patients (95%) who had not crossed over to surgery had an improvement of ≥1 functional class, and 13% remained improved after a mean follow-up of 28 ± 17 months. Long-term survival of older patients was compared with that of our first 96 younger ones dilated before 1990. The total survival rate at 3 years was 70% in older patients and 92% in younger ones (p < 0.001). Thus, BMC can be an effective therapy for parents aged ≥70 years, but has an increased risk of morbidity and mortality compared with in younger ones. However, the hemodynamic success rate in patients aged ≥70 years with the completed procedure, and the long-term cardiac survival in those with a good initial result are similar to those in younger ones. Therefore, BMC can be performed in older patients with an acceptable risk compared with that of medical treatment or surgery.