Author + information
- Received April 18, 2018
- Revision received May 8, 2018
- Accepted May 22, 2018
- Published online August 1, 2018.
- Rafael A. Meneguz-Moreno, MDa,b,∗ (, )
- J. Ribamar Costa Jr., MD, PhDa,
- Nisia L. Gomes, MDc,
- Sergio L.N. Braga, MD, PhDa,
- Auristela I.O. Ramos, MD, PhDc,
- Zilda Meneghelo, MD, PhDc,
- Mercedes Maldonado, MDd,
- Alfredo N. Ferreira-Neto, MDa,
- J. Italo D. Franca, BS, MSce,
- Dimytri Siqueira, MD, PhDa,
- Cesar Esteves, MD, PhDa,
- Amanda Sousa, MD, PhDa,
- J. Eduardo Sousa, MD, PhDa and
- Alexandre Abizaid, MD, PhDa
- aDepartment of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
- bDepartment of Medicine, Universidade Federal de Sergipe, Sergipe, Brazil
- cDepartment of Structural Heart Disease, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
- dDepartment of Echocardiography, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
- eDepartment of Biostatistics, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
- ↵∗Address for correspondence:
Dr. Rafael A. Meneguz-Moreno, Av. Dante Pazzanese, n. 500, 04012-909, Sao Paulo, Brazil.
Objectives The aim of this study was to assess very long term outcomes after successful percutaneous balloon mitral valvuloplasty (PBMV).
Background PBMV remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis and suitable anatomy.
Methods All consecutive patients who underwent successful PBMV between 1987 and 2010 were included. The primary endpoint was the composite of all-cause mortality, need for mitral surgery, or repeat PBMV up to 23 years.
Results Among all 1,582 consecutive patients undergoing PBMV, acute success was achieved in 90.9% (1,438 patients). Independent predictors of acute success included left atrial size (odds ratio: 0.96; 95% confidence interval [CI]: 0.93 to 0.99; p = 0.045), Wilkins score ≤8 (odds ratio: 1.66; 95% CI: 0.48 to 0.93; p = 0.02) and age (odds ratio: 0.97; 95% CI: 0.96 to 0.99; p = 0.006). Very long term follow-up (median 8.3 years, mean 15.6 years) was obtained in 79.1% of successful cases. The incidence of the primary endpoint was 19.1% (95% CI: 17.0% to 21.1%). The rates of overall mortality, need for mitral valve surgery, or repeat PBMV were 0.6% (95% CI: 0.3% to 1.2%), 8.3% (95% CI: 7.0% to 9.9%), and 10.0% (95% CI: 8.5% to 11.7%), respectively. On multivariate analysis, New York Heart Association functional class III or IV (hazard ratio: 1.62; 95% CI: 1.26 to 2.09; p < 0.001), higher age (hazard ratio: 0.97; 95% CI: 0.96 to 0.98; p = 0.028), and mitral valve area ≤1.75 cm2 after the procedure (hazard ratio: 1.67; 95% CI: 1.28 to 2.11; p = 0.028) were independent predictors of the primary endpoint.
Conclusions In very long term follow-up, more than 75% of patients exhibited sustained results. Prediction of late favorable results is multifactorial and strongly determined by age, previous symptoms and post-procedural mitral valve area.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 18, 2018.
- Revision received May 8, 2018.
- Accepted May 22, 2018.
- 2018 American College of Cardiology Foundation
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