Author + information
- Ivana Picone Borges Aragao1,
- Rodrigo Peixoto1,
- Ricardo Peixoto1,
- Alexandre Augustus Brito Aragao1,
- Ivan Lucas Picone Borges Anjos2,
- Livia Liberata Barbosa Bandeira2,
- Vanessa Freitas Marcolla1 and
- Edison Carvalho Sandoval Peixoto1
The single balloon (SB) is the less expensive technique to perform mitral balloon valvuloplasty (MBV). This study aimed to demonstrate that MBV done with SB Balt has a similar outcome and long-term follow-up (FU) than MBV done with the Inoue worldwide accepted technique. From 1987 to 12/31/2013, a total of 526 procedures were performed, being 313 with a FU, 57 (18.8%) with Inoue balloon (IB), the IB group (IBG) and 256 (82.1%) SB Balt group (SBG). The mean FU in IBG was 33±27 (2 to 118) months and in SBG 55±33 (1 to 198) months (p<0.0001). Univariate analysis and multivariate Cox analysis were utilized to determine independent prediction of survival variables and event free survival (EFS) in both technique groups being major events (ME): death, cardiac surgery and new MBV.
In IBG and SBG there were 43 female patients (75.4%) and 222 (86.7%) procedures, (p=0.0276), mean age was 37.3±10.0 (19 to 63) and 38.0±12.6 (13 to 83) years (p=0.7138), sinus rhythm 51 (91.1%) and 215 (84.0%), (p=0.1754), echo score (ES) 7.6±1.3 (5 to 10) and 7.2±1.5 (4 to 14) points (p=0.0528), echo mitral valve area (MVA) pre-MBV 0.96±0.18 and 0.93±0.21 cm2 (p=0.2265). Post-MBV mean MVA (Gorlin) were 2.00±0.52 and 2.02±0.37 cm2 (p=0.9550) and at the end of the FU: echo MVA 1.71±0.41 and 1.54±0.51 cm2 (p=0.0552), new severe mitral regurgitation in 5 (8.9%) and 17 (6.6%) patients (p=0.5633), new MBV in 1 (1.8%) and 13 (5,1%), (p=0.4779), mitral valve surgery in 3 (5.4%) and 27 (10.4%), (p=0.3456), deaths 2 (3.6%) and 11 (4.3%) deaths, (p=1.000), cardiac deaths 1 (1.8%) and 9 (3.5%), (p=1.0000), ME 5 (8.9%) and 46 (18.0%), (p=0.1449). In univariate analysis and in multivariate Cox analysis the SB or IB do not predict survival or event-free survival and independent risk factors to survival in multivariate Cox analysis with 2 models with 5 and 6 variables were age <50 years (p=0.016, HR=0.233, CI 95% 0.071-0,764), ES ≤8 (p<0.001, HR=0.105, CI 95% 0.34-0.327), MBV dilatation area (p<0.001, HR=16.838, CI 95% 3.353- 84.580) and no mitral valve surgery in the FU (p=0.001, HR=0.152, CI 95% 0.050-0.459) and to event-free survival: no prior commissurotomy (p=0.012, HR=0.390, CI 95% 0.187-0.813) and post-MBV MVA ≥1.50 cm2 (p<0.001, HR=7.969, CI 95% 3.413-18.608).
MBV with BSB and IB were equally efficient. There were similar survival and EFS in the FU. Independent predictors of survival were age <50 years, ES≤8 points, MBV dilatation area > 7 mm2 and no mitral valve surgery in the FU. Independent risk factors of EFS were no prior commissurotomy and post-MBV MVA≥1.50 cm2.