Percutaneous transvenous mitral commissurotomy: with or without heparin? A randomised double blind study

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Percutaneous transvenous mitral commissurotomy (PTMC) is a less invasive alternative to open heart surgery for symptomatic mitral stenosis (MS).
• The role of heparin in mitigating procedural risks during PTMC remains an area of investigation.

Purpose of the Study:

• To evaluate the efficacy of heparin administration during PTMC in preventing embolic events.
• To compare clinical and echocardiographic outcomes of PTMC with and without heparin.

Main Methods:

• A randomized clinical trial involving 480 patients with symptomatic MS undergoing PTMC.
• Patients were assigned to groups with or without heparin administration.
• Outcomes including mitral valve area (MVA) and embolic events were assessed pre-procedure, during hospitalization, and at one-month follow-up.

Main Results:

• No significant difference in MVA increase between the heparin and no-heparin groups (0.85 vs 0.88 cm²).
• Embolic events were rare and similar in both groups (0.83% with heparin vs 0.42% without).
• Rates of hematoma and urgent surgery were comparable between groups.

Conclusions:

• Heparin administration during PTMC is not associated with a reduced risk of short-term embolic events in selected patients without left atrial thrombus.
• These findings suggest that heparin may not be necessary in high-volume centers for specific patient populations undergoing PTMC.