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Left atrial size predicts long-term outcome after balloon mitral valvuloplasty
Affiliations- Leviev Cardiovascular Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
- Department of Internal Medicine H, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
open access
Abstract
Background: The treatment of choice for severe rheumatic mitral stenosis is balloon mitral valvuloplasty (BMV). Numerous predictors of immediate and long-term procedural success have been described. The aims of this study were to describe our experience with BMV over the last decade and to evaluate predictors of long-term event-free survival. Methods: Medical records were retrospectively analyzed of patients who underwent BMV between 2009 and 2021. The primary outcome was a composite endpoint of all-cause mortality, mitral valve replacement (MVR), and repeat BMV. Long-term event-free survival was estimated using the Kaplan-Meier curves. Logistic regression was used to create a multivariate model to assess pre-procedural predictors of the primary outcome. Results: A total of 96 patients underwent BMV during the study period. The primary outcome occurred in 36 patients during 12-year follow-up: 1 (1%) patient underwent re-BMV, 28 (29%) had MVR, and 8 (8%) died. Overall event-free survival was 62% at 12 years. On multivariate analysis, pre-procedural left atrial volume index (LAVI) > 80 mL/m2 had a significant independent influence on event-free survival, as did previous mitral valve procedure and systolic pulmonary arterial pressure above 50 mmHg. Conclusion: Despite being a relatively low-volume center, excellent short and long-term results were demonstrated, with event-free survival rates consistent with previous studies from high-volume centers. LAVI independently predicted long-term event-free survival.
Abstract
Background: The treatment of choice for severe rheumatic mitral stenosis is balloon mitral valvuloplasty (BMV). Numerous predictors of immediate and long-term procedural success have been described. The aims of this study were to describe our experience with BMV over the last decade and to evaluate predictors of long-term event-free survival. Methods: Medical records were retrospectively analyzed of patients who underwent BMV between 2009 and 2021. The primary outcome was a composite endpoint of all-cause mortality, mitral valve replacement (MVR), and repeat BMV. Long-term event-free survival was estimated using the Kaplan-Meier curves. Logistic regression was used to create a multivariate model to assess pre-procedural predictors of the primary outcome. Results: A total of 96 patients underwent BMV during the study period. The primary outcome occurred in 36 patients during 12-year follow-up: 1 (1%) patient underwent re-BMV, 28 (29%) had MVR, and 8 (8%) died. Overall event-free survival was 62% at 12 years. On multivariate analysis, pre-procedural left atrial volume index (LAVI) > 80 mL/m2 had a significant independent influence on event-free survival, as did previous mitral valve procedure and systolic pulmonary arterial pressure above 50 mmHg. Conclusion: Despite being a relatively low-volume center, excellent short and long-term results were demonstrated, with event-free survival rates consistent with previous studies from high-volume centers. LAVI independently predicted long-term event-free survival.
Keywords
mitral valve, mitral stenosis, balloon mitral valvuloplasty, left atrial size, event-free survival
About this articleTitle
Left atrial size predicts long-term outcome after balloon mitral valvuloplasty
Journal
Issue
Article type
Original Article
Published online
2022-10-04
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761
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196
DOI
Pubmed
Keywords
mitral valve
mitral stenosis
balloon mitral valvuloplasty
left atrial size
event-free survival
Authors
Michal Canetti
Rafael Kuperstein
Ido Cohen
Shir Raibman-Spector
Elad Maor
Ilan Hai
Israel M. Barbash
Ehud Regev
Adi Butnaru
Amit Segev
Victor Guetta
Paul Fefer
References (30)- Coffey S, Roberts-Thomson R, Brown A, et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol. 2021; 18(12): 853–864.
- Inoue K, Owaki T, Nakamura T, et al. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984; 87(3): 394–402.
- Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021; 77(4): e25–e197.
- Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988; 60(4): 299–308.
- Hernandez R, Bañuelos C, Alfonso F, et al. Long-term clinical and echocardiographic follow-up after percutaneous mitral valvuloplasty with the Inoue balloon. Circulation. 1999; 99(12): 1580–1586.
- Prota-Filho LE, Meneguz-Moreno RA, Queiroz CCV, et al. Novel prognostic score for immediate and late success after percutaneous mitral balloon commissurotomy in patients with mitral stenosis. J Invasive Cardiol. 2020; 32(6): 211–217.
- Vahanian A, Michel PL, Cormier B, et al. Results of percutaneous mitral commissurotomy in 200 patients. Am J Cardiol. 1989; 63(12): 847–852.
- Vahanian A, Michel PL, Cormier B, et al. Immediate and mid-term results of percutaneous mitral commissurotomy. Eur Heart J. 1991; 12 Suppl B: 84–89.
- Meneguz-Moreno RA, Costa JR, Gomes NL, et al. Very long term follow-up after percutaneous balloon mitral valvuloplasty. JACC Cardiovasc Interv. 2018; 11(19): 1945–1952.
- Hung JS, Chern MS, Wu JJ, et al. Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy. Am J Cardiol. 1991; 67(9): 854–862.
- Palacios IF, Block PC, Wilkins GT, et al. Follow-up of patients undergoing percutaneous mitral balloon valvotomy. Analysis of factors determining restenosis. Circulation. 1989; 79(3): 573–579.
- Iung B, Cormier B, Ducimetière P, et al. Immediate results of percutaneous mitral commissurotomy. A predictive model on a series of 1514 patients. Circulation. 1996; 94(9): 2124–2130.
- Cruz-Gonzalez I, Sanchez-Ledesma M, Sanchez PL, et al. Predicting success and long-term outcomes of percutaneous mitral valvuloplasty: a multifactorial score. Am J Med. 2009; 122(6): 581.e11–581.e19.
- Iung B, Garbarz E, Michaud P, et al. Late results of percutaneous mitral commissurotomy in a series of 1024 patients. Analysis of late clinical deterioration: frequency, anatomic findings, and predictive factors. Circulation. 1999; 99(25): 3272–3278.
- Tomai F, Gaspardone A, Versaci F, et al. Twenty year follow-up after successful percutaneous balloon mitral valvuloplasty in a large contemporary series of patients with mitral stenosis. Int J Cardiol. 2014; 177(3): 881–885.
- Cohen DJ, Kuntz RE, Gordon SP, et al. Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty. N Engl J Med. 1992; 327(19): 1329–1335.
- Dadjo Y, Moshkani Farahani M, Nowshad R, et al. Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis. BMC Cardiovasc Disord. 2021; 21(1): 355.
- Meneveau N, Schiele F, Seronde MF, et al. Predictors of event-free survival after percutaneous mitral commissurotomy. Heart. 1998; 80(4): 359–364.
- Fawzy ME. Long-term results up to 19 years of mitral balloon valvuloplasty. Asian Cardiovasc Thorac Ann. 2009; 17(6): 627–633.
- Bouleti C, Iung B, Laouénan C, et al. Late results of percutaneous mitral commissurotomy up to 20 years: development and validation of a risk score predicting late functional results from a series of 912 patients. Circulation. 2012; 125(17): 2119–2127.
- Song JK, Song JM, Kang DH, et al. Restenosis and adverse clinical events after successful percutaneous mitral valvuloplasty: immediate post-procedural mitral valve area as an important prognosticator. Eur Heart J. 2009; 30(10): 1254–1262.
- Jorge E, Pan M, Baptista R, et al. Predictors of very late events after percutaneous mitral valvuloplasty in patients with mitral stenosis. Am J Cardiol. 2016; 117(12): 1978–1984.
- Bouleti C, Iung B, Himbert D, et al. Reinterventions after percutaneous mitral commissurotomy during long-term follow-up, up to 20 years: the role of repeat percutaneous mitral commissurotomy. Eur Heart J. 2013; 34(25): 1923–1930.
- Kim D, Chung H, Nam JHo, et al. Predictors of long-term outcomes of percutaneous mitral valvuloplasty in patients with rheumatic mitral stenosis. Yonsei Med J. 2018; 59(2): 273–278.
- Orrange SE, Kawanishi DT, Lopez BM, et al. Actuarial outcome after catheter balloon commissurotomy in patients with mitral stenosis. Circulation. 1997; 95(2): 382–389.
- Zamorano JL, Badano LP, Bruce C, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. Eur Heart J. 2011; 32(17): 2189–2214.
- Garbarz E, Iung B, Cormier B, et al. Echocardiographic criteria in selection of patients for percutaneous mitral commissurotomy. Echocardiography. 1999; 16(7, Pt 1): 711–721.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
- Gorlin R, Gorlin SG. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J. 1951; 41(1): 1–29.
- Dean LS, Mickel M, Bonan R, et al. Four-year follow-up of patients undergoing percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry. J Am Coll Cardiol. 1996; 28(6): 1452–1457.
