Very Long Term Follow-Up After Percutaneous Balloon Mitral Valvuloplasty

ABSTRACT

OBJECTIVES: The aim of this study was to assess very long term outcomes after successful percutaneous balloon mitral valvuloplasty (PBMV).BACKGROUND: PBMV remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis and suitable anatomy.METHODS: All consecutive patients who underwent successful PBMV between 1987 and 2010 were included. The primary endpoint was the composite of all-cause mortality, need for mitral surgery, or repeat PBMV up to 23 years.RESULTS: Among all 1,582 consecutive patients undergoing PBMV, acute success was achieved in 90.9% (n»1,438).Independent predictors of acute success included left atrial size (odds ratio 0.96; 95% confidence interval [CI] 0.93 to0.99; p»0.045), Wilkins score#8 (odds ratio 1.66; 95% CI 0.48 to 0.93; p»0.02) and age (odds ratio 0.97; 95% CI0.96 to 0.99; p»0.006). Very long-term follow-up (median 8.3 years, mean 15.6 years) was obtained in 79.1% of successful cases. The incidence of the primary endpoint was 19.1% (95% CI 17.0% to 21.1%). The rates of overall lmortality, need for mitral valve surgery, or repeat PBMV were 0.6% (95% CI 0.3% to 1.2%), 8.3% (95% CI 7.0% to9.9%), and 10.0% (95% CI 8.5% to 11.7%), respectively. On multivariate analysis, New York Heart Association functional class III or IV (hazard ratio 1.62; 95% CI 1.26 to 2.09; p<0.001), higher age (hazard ratio 0.97; 95% CI 0.96 to0.98; p»0.028), and mitral valve area#1.75 cm2after the procedure (hazard ratio 1.67; 95% CI 1.28 to 2.11;p»0.028) were independent predictors of the primary endpoint. CONCLUSIONS: In very long term follow-up, more than 75% of patients exhibited sustained results. Prediction of late favorable results is multifactorial and strongly determined by age, previous symptoms and post-procedural mitral valve area.(J Am Coll Cardiol Intv 2018;111945­52) © 2018 by the American College of Cardiology Foundation.