Author + information
- Edison Carvalho Sandoval Peixoto1,
- Rodrigo Trajano Sandoval Peixoto2,
- Ricardo Trajano Sandoval Peixoto3 and
- Ivana Picone Borges4
Mitral balloon valvuloplasty (MBV) with single balloon (MBVSB) is the less expensive technique to perform MBV. The objectives were to evaluate long-term follow-up (FU) of MBVSB Balt and to determine independent predictors of survival and event-free survival.
From 1987 to 12-31-2012, 526 procedures of mitral balloon valvuloplasty was performed, 404 (76.8%) with MBVSB Balt, being 256 procedures with long-term FU. The balloon diameter was 25 mm in 5 procedures and 30 mm in 251, mean dilatation area 7.02±0.30 cm2. The FU was 55±33 (1 to 198) months. To determine independent predictors of survival and event-free survival it was used the multivariate Cox analysis.
Mean age was 38.0±12.6 (13 to 83) years, being 222 (86.7%) female, 215 (84.0%) in sinus rhythm, echo score (ES) 7.2±1.5 (4 to 14) points and echo mitral valve area (MVA) pre-MBVSB 0.93±0.21 cm2. Mean pre and post-mitral balloon valvuloplasty area (Gorlin) was 0.90±0.20 and 2.02±0.37 cm2 (p<0.001) and success MVA ≥1,5 cm2 in 241 (94.1%) procedures and mean pulmonary artery pressure pre and post MBV were 27±10 and 20±7 mmHg . Three (1.2%) patients began the FU with severe mitral regurgitation. At the end of the FU 118 (46.1%) patients were in NYHA FC I, 71 (27.7%) in FC II, 53 (20.7%) in FC III, 3 (1.2%) in FC IV and there were 11 deaths (4.3%), 9 (3,5%) were cardiac death, being 5 during cardiac surgery. There were 17 (8.2%) patients with new severe mitral regurgitation at the end of the FU. Twelve (4.7%) patients were submitted to new mitral balloon valvuloplasty, 27 (10.5%) to mitral valve surgery and 70 (26.3%) patients used no medication at the end of the FU. Independent predictors of survival with 7 variables were: ES ≤8 (P<0.002, HR=0.143), age ≤50 years old (P=0.014, HR 0.202 and absence of mitral valve surgery in the FU (P=0.004, HR 0.170), being cardiac surgery in fhe FU the 7th variable and with 6 variables independent predictors were: EE ≤8 (p<0.001, HR 0,116) and age ≤50 years old (P=0,011, HR=0,203). Independent predictors of event-free survival were: absence of prior comissurotomy (P<0.002, HR 0.318), female (P=0.036, HR 0.466) and MVA post mitral balloon valvuloplasty ≥1.50 cm2, P<0.001, HR 0.466) in multivariate Cox analysis.
MBVSB Balt was efficient with durable results similar to other techniques. Independent predictors of survival were: ES ≤8, age ≤50 years old and absence of mitral valve surgery in the FU. Independent predictors of event-free survival were: absence of prior comissurotomy, female gender and MVA post mitral balloon valvuloplasty ≥1.50 cm2.