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Complications of Inoue balloon mitral commissurotomy: impact of operator experience and evolving technique
1Section of Cardiology, China Medical College and Hospital, Taichung, Taiwan, Republic of China. h1989jsh@ms16.hinet.net
Background:
There have been no single-center studies that have systematically addressed the acute outcome of Inoue balloon mitral commissurotomy (BMC) performed in a large series of patients. Accordingly, this study sought to examine the impact of operator experience and continuing technical modifications on the success and complication rates of BMC.
Methods:
BMC was performed in 799 patients: 469 patients with pliable mitral valves (group 1) and 330 patients with calcified valves and/or severe subvalvular disease (group 2). Acute complications were examined and compared between groups before and after modifications in BMC techniques. Major modifications included the use of a height-derived balloon sizing method for the selection of an appropriate balloon catheter, a cautionary stepwise dilation technique, and avoidance of traction on the interatrial septum during balloon inflations.
Results:
Technical failures were encountered in 4 (0.5%) patients in our early experience. One patient sustained cardiac perforation and tamponade and was the only case requiring emergency surgery. There were no deaths. Systemic embolic events were observed in 11 (1.4%), all among the first 353 patients before the routine use of pre-BMC transesophageal echocardiography. Severe postprocedure angiographic (>/=3+) mitral regurgitation occurred in 4% of patients, 2% in group 1 versus 9% in group 2 (P =.0001). With increased operator experience and technical modifications, this complication was significantly reduced from 5% (7 of 150 patients) to 0% in the last 316 patients in group 1 (P =.0001) and from 11% (26 of 228 patients) to 3% (3 of 101 patients) in group 2 (P =.031). The incidence of significant interatrial shunting (pulmonary-to-systemic flow ratio >/=1.3) was also significantly reduced from 12% to 6% (P =.0034).
Conclusion:
Incremental operator experience and ongoing technical refinements in BMC techniques have resulted in a 100% technical success rate and a significant diminution in complications in patients with a wide spectrum of stenotic mitral valve morphologic features.
Insights
Inoue balloon mitral commissurotomy (BMC) shows a 100% success rate with reduced complications. Operator experience and technical improvements significantly decrease adverse events like mitral regurgitation and interatrial shunting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- No prior single-center studies systematically evaluated acute outcomes of Inoue balloon mitral commissurotomy (BMC) in large patient cohorts.
- This study addresses the need for comprehensive data on BMC's acute outcomes, focusing on operator experience and technical modifications.
Purpose of the Study:
- To assess the impact of operator experience and technical refinements on the success and complication rates of Inoue balloon mitral commissurotomy (BMC).
- To analyze acute outcomes in a large series of patients undergoing BMC for mitral stenosis.
Main Methods:
- BMC was performed on 799 patients, categorized into pliable (group 1, n=469) and calcified/subvalvular disease (group 2, n=330) valves.
- Acute complications were compared before and after implementing major modifications: height-derived balloon sizing, stepwise dilation, and avoiding interatrial septum traction.
- Pre-BMC transesophageal echocardiography was routinely used after initial experience.
Main Results:
- Overall technical failure rate was low at 0.5% (4 patients), with one requiring emergency surgery for perforation and tamponade; no deaths occurred.
- Systemic embolic events (1.4%) were exclusively observed in the early patient cohort before routine transesophageal echocardiography.
- Severe mitral regurgitation decreased significantly with experience and modifications, from 5% to 0% in group 1 (P=.0001) and 11% to 3% in group 2 (P=.031).
- Significant interatrial shunting incidence reduced from 12% to 6% (P=.0034).
Conclusions:
- Incremental operator experience and technical refinements led to a 100% technical success rate in Inoue balloon mitral commissurotomy.
- These advancements significantly reduced complications, including mitral regurgitation and interatrial shunting, across diverse mitral valve morphologies.
- BMC is a safe and effective procedure for mitral stenosis, with outcomes improving substantially through experience and technique optimization.