Percutaneous mitral balloon valvuloplasty beyond 65 years of age

Abstract

Background: The profile of subjects undergoing percutaneous mitral balloon valvuloplasty (PMBV) in developed countries has shifted toward the elderly. In the group of elderly patients long-term results after PMBV, as well prognostic factors that may improve patient selection for this procedure have not been fully elucidated. Aim of the study was to evaluate the safety and efficacy of PMBV for the treatment of mitral stenosis in patients older than 65.
Methods: The studied group consists of 132 consecutive patients aged > 65, who underwent PMBV. All PMBV procedures were performed by the antegrade transvenous approach using the Inoue balloon system.
Results: Procedural success, defined as mitral valve area ≥ 1.5 cm2 and mitral regurgitation £ 2+, was obtained in 105 (79.5%) patients. Mean follow-up was 6.25 ± 4.33 years. Echo score > 8 and higher mean mitral valve gradient were significant independent predictors of inadequate immediate result. Survival curves showed that for the whole studied group after PMBV the 3-, 5-, and 10-year overall survival rates were significantly better in patients with left atrium diameter £ 5.0 cm before intervention (95.4%, 91.3% and 80.5% vs. 89.6%, 69.5%, and 53.7%, respectively; p = 0.002). Survival free of mitral valve intervention or heart failure ≥ NYHA III was significantly better for patients with good immediate result and mean pulmonary artery pressure after PMBV < 25 mm Hg.
Conclusions: PMBV is safe and efficacious in elderly patients with symptomatic mitral stenosis. Long-term results are good and related mainly to the quality of the procedure.