Percutaneous mitral commissurotomy in patients over 50 years old: Immediate and long-term results

Abstract

Describe the immediate and final outcome of percutaneous mitral balloon commissurotomy (PMC) with Inoue balloon in patients over 50 years old and associate complications with age and Wilkins score. A retrospective and analytic study was performed with a database of 280 patients. We included all the patients proceeding in our department from January 1998 to December 2012. Seventy-five were > or = 50-years old (group 1). Immediate and late outcomes in this group (group 1) were compared with those in the patients aged < 50-years (group 2). Baseline hemodynamic parameters were comparable in the two groups. The Wilkins score was > 8 in 11 patients We found a Mitral Valvular Area (MVA) before the PMC proceeding of 0.99 cm 2 ± 0.2 and 1.87 cm 2 ± 0.38 post-PMC ( P < 0.001), with pre-procedure transmitral gradient of 12.7 ± 4.05 mmHg and of 4.4 ± 2.3 mmHg post-procedure ( P < 0.001). Similar significant improvements were seen in group 2. In 72 patients (96%) the immediate proceeding was considered successful. The hemodynamic result was good in 85.3% of group 1 patients. Tamponade occurred in one patient. Mitral regurgitation grade I or II developed in 8 patients and remained stable in 19 patients. These complication rates were comparable to those seen in group 2. A clinical and echocardiographic follow-up was performed in 68 patients (93%). In the group 1, a good result was maintained in 60% of patients after 75.8 ± 40 months of follow-up. Although restenosis was observed in 28% of patients, functional amelioration was obtained in most of cases. Survival free of mitral valve intervention or heart failure ≥ NYHA III was significantly better for patients with good immediate result. PMC is safe and efficacious in elderly patients with symptomatic mitral stenosis. Long-term results are good and related mainly to the quality of the procedure.