Repeat Percutaneous Balloon Mitral Valvotomy vs Mitral Valve Replacement in Patients With Restenosis After Previous Balloon Mitral Valvotomy and Unfavorable Valve Characteristics

Abstract

Symptomatic mitral restenosis develops in up to 21% of patients after percutaneous balloon mitral valvotomy (PBMV), and most of these patients undergo mitral valve replacement (MVR). Repeating PBMV (re-PBMV) might be an effective and less-invasive treatment for these patients. Forty-seven patients with post-PBMV mitral restenosis and unfavorable valve characteristics were assigned either to re-PBMV (25 cases; mean age 40.7 ± 11 y, 76% female) or MVR (22 cases; mean age 47 ± 10 y, 69% female) at 51 ± 33 months after the prior PBMV. The mean follow-up was 41 ± 32 months and 63 ± 30 months for the re-PBMV and MVR groups, respectively. The 2 groups were homogenous in preoperative variables such as gender, echocardiographic findings, and valve characteristics. Patients in the MVR group were older, with a higher mean New York Heart Association functional class, mean mitral valve area, mitral regurgitation grade, and right ventricular systolic pressure (P = 0.03), and more commonly were in AF. There were 3 in-hospital deaths (all in the MVR group) and 4 during follow-up (3 in the MVR group and 1 in the re-PBMV group). Ten-year survival was significantly higher in re-PBMV vs MVR (96% vs. 72.7%, P<0.05), but event-free survival was similar (52% vs. 50%, P = 1.0) due to high reintervention in the re-PBMV group (48% vs. 18.1%, P = 0.02). In a population with predominantly unfavorable characteristics for PBMV, short- and long-term outcomes are both reasonable after re-PBMV with less mortality but requiring more reinterventions compared with MVR.