Balloon Mitral Valvuloplasty at Very Long Term

With a mean follow up of 15 years, and some patients that survived over 20 years, this study shows that more than 75% of patients with rheumatic mitral stenosis show sustained results with balloon valvuloplasty. Predictors of this excellent long-term outcome are many, but they are determined mainly by age, prior symptoms and valve area obtained after procedure.  

Over the years, mitral valvuloplasty has remained the preferred treatment for patients with rheumatic mitral stenosis and suitable anatomy.

All consecutive patients undergoing balloon valvuloplasty between 1987 and 2010 were included. Primary end-point was a composite of all cause death, need for mitral surgery or repeat valvuloplasty at up to 23 years.

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In all, 1582 patients were included over the years and success was achieved in 90.9% of the population. I independent predictors of intraprocedural success were left atrial size (OR 0.96, p=0.045), Wilkins score ≤8 (OR 1.66, p=0.045), and age (OR 0.97, p=0.006).

Very long-term follow-up (mean follow up = 15.6 years) was obtained in 79.1% of the population, with 19.1% incidence of the primary end-point. Separately, mortality resulted as low as 0.6%, need for valve surgery, 8.3%, and repeat valvuloplasty, 10%.

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On multivariable analysis, functional class III-IV (HR 1.62, p<0.001), older age (HR 0.97, p=0.028 and post procedural mitral area ≤1.75 cm² (HR 1.67; p=0.028) were independent predictors of the primary end point.

Conclusion

Time goes by and mitral valvuloplasty remains the preferred treatment for patients with rheumatic mitral stenosis and suitable anatomy, given its excellent results even after 20 years.

Original Title: Very Long Term Follow-Up After Percutaneous Balloon Mitral Valvuloplasty.

Reference: Rafael A. Meneguz-Moreno et al. J Am Coll Cardiol Intv 2018. Article in press.

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