Author + information
- Ivana Picone Borges Aragao1,
- Edison Peixoto1,
- Ricardo Peixoto1,
- Rodrigo Peixoto1,
- Ivan Lucas Picone Borges Anjos2,
- Livia Liberata Barbosa Bandeira2,
- Caio Teixeira Santos2,
- Lahis Werneck Vilagra2,
- Thais Lemos de Souza Macedo2,
- Dandhara Martins Rebello2,
- Thamires Politano de Sant’ Anna Alves2,
- Vanessa Freitas Marcolla3,
- Sandra Maria Barroseo Werneck Vilagra2 and
- Alexandre Augustus Brito Aragao1
Mitral balloon valvuloplasty with Inoue balloon is the worldwide accepted procedure technique. The aims of this study is to evaluate the long-term follow-up (FU) of mitral balloon valvuloplasty (MBV) with Balt single balloon (BSB) technique and to determine independent predictors of survival and event-free survival (EFS).
From 1987 to 12-31-2013, 526 procedures of MBV were perfomed, 404 (77.1%) with BSB. There were 256 procedures with long-term FU. Balloon diameter was 25 mm in 5 procedures and 30 mm in 251.Mmean dilatation area was 7.02±0.30 cm2. FU was 156 ± 144 months. Multivariate Cox analysis was performed to determine IPS and EFS.
Mean age was 38.0±12.6 (13 to 83) years, 222 (86.7%) female gender, 215 (84.0%) sinus rhythm, echo score (ES) 7.2±1.5 (4 to 14) points and echo mitral valve area (MVA) pre-MBV 0.93±0.21 cm2. Mean pre and post-MVA (Gorlin): 0.90±0.20 and 2.02±0.37 cm2, respectively (p<0.001). Success (MVA ≥1.5 cm2): 241 (94.1%) procedures. Mean pulmonary artery pressure pre and post-MBV: 27±10 and 20±7 mmHg, respectively. Three (1.2%) patients began the FU with severe mitral regurgitation (SMR). At the end of FU 119 (46.5%) patients were in NYHA funcional class (FC) I; 70 (27.3%) in FC II; 53 (20.7%) in FC III; 3 (1.2%) in FC IV; 11 (4,3%) deaths; 17 (8.2%) patients with SMR; 20 (4.7%) were submitted to a new MBV; 27 (10.5%) to mitral valve surgery and 70 (26.3%) without any medicine. Independent predictors of survival were: ES ≤8 points (p<0.001, HR0.116, 95% IC 0.035-0.384), age ≤50 years old (p=0.011, HR 0.203, 95% IC 0.059-0.693) and absence of mitral valve surgery in the FU (p=0.004, HR 0.170, 95% IC 0.050-0.571). Independents of EFS were: absence of prior commissurotomy (p<0.002, HR 0.318, 95% IC 0.151-0.667), female gender (p=0.036, HR 0.466, 95% IC 0.229-0.951) and MVA post-MBV ≥1.50 cm2 (p<0.001, HR 0.466, 95% IC 4.884-28.457).
Success in 94% of procedures. At the end of follow-up (25 years) only 4,3% of mortality. The independent predictors of survival were ES ≤8 points, age ≤50 years old and absence of mitral valve surgery in the FU. Independent predictors of EFS were absence of prior commissurotomy, female gender and MVA post-MBV ≥1.50 cm2