Cardiac surgery after failed percutaneous mitral valvuloplasty

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Percutaneous mitral valvuloplasty (PMV) is an alternative to surgical interventions for symptomatic mitral stenosis (MS).
• Selected patients with MS may undergo PMV as a less invasive option.
• The safety and efficacy of PMV require careful evaluation, especially regarding potential complications.

Purpose of the Study:

• To evaluate the outcomes of percutaneous mitral valvuloplasty (PMV) in patients with symptomatic mitral stenosis (MS).
• To assess the rate of urgent corrective surgery required after PMV.
• To compare the mortality associated with PMV complications versus primary surgical treatments.

Main Methods:

• A retrospective analysis of 146 consecutive patients undergoing PMV between March 1987 and April 1990.
• Identification of patients requiring urgent corrective surgery post-PMV.
• Comparison of operative mortality rates between PMV complications and initial open mitral commissurotomy (OMC) or mitral valvular replacement (MVR).

Main Results:

• 18 patients (12%) required urgent corrective surgery after PMV.
• Indications included mitral regurgitation, cardiac perforation, technical failure, and atrial shunting.
• The operative mortality rate for these 18 patients was 22%, significantly higher than primary OMC (0%) or MVR (3.1%).

Conclusions:

• Percutaneous mitral valvuloplasty (PMV) can be associated with significant complications requiring urgent surgery.
• The high mortality rate following PMV complications underscores the need for careful patient selection.
• Aggressive and timely corrective surgery is crucial to mitigate morbidity and mortality in patients experiencing PMV failure.