Immediate Outcomes and Long-Term Follow-Up of Percutaneous Mitral Valvuloplasty

pp. 28-35

Abstract

Background
The treatment of mitral valve stenosis has changed over the last decades. Hemodynamic results and clinical outcome of percutaneous mitral valvuloplasty (PMV) have proved to be comparable to those of surgical treatment.

Objective
The aim of this study was to evaluate the efficacy and the immediate and long-term clinical and echocardiographic outcome of PMV.

Methods
A total of 132 patients undergoing PMV were included, with a median follow-up of 48 months. Primary success was defined as mitral valve area ≥ 1.5 cm2 following PMV. Mortality, need for mitral valve replacement or new PMV and mitral valve restenosis
were evaluated during follow-up.

Results
Mean age was 44.6 years and 88.5% of patients (n=115) were women. Median mitral valve area before PMV was 0.90 cm2 (IQR 25-75: 0.81-1.00), systolic pulmonary ar tery pressure was 44 mm Hg (IQR 25-75: 35-52) and the echocardiographic score was 7 (25-75 % IQR: 6-9). Primary success was achieved in 104 patients (78.8%). After 4-year follow-up, 86.5% of patients (n=109) were free of symptoms. Three patients (2.2%) died during hospitalization and three (2.2%) during follow-up. A new PMV was performed in 10 patients and four patients underwent mitral valve replacement. At follow-up, an echocardiographic score >8 (p=0.04) and mitral valve area follow ing PMV <1.8 cm2 (p=0.02) were associated with restenosis. After performing multivariate analysis, mitral valve area <1.8 cm2 was the only predictor of restenosis after PMV (OR: 2.6; 95% CI: 1.08-6.25).

Conclusions
Percutaneous mitral valvuloplasty is a safe and efficient method with long-term efficacy. The best outcomes are achieved in patients with low echocardiographic score and in sinus rhythm and those with larger mitral valve area after PMV have lower
restenosis during follow-up.