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Outcomes of Severe Mitral Stenosis With the Revised Severity Criteria: Mitral Valve Replacement vs Percutaneous

Dae-Young Kim1, Iksung Cho2, Kyu Kim2

  • 1Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.

The Canadian Journal of Cardiology
|September 16, 2023
PubMed
Abstract

Insights

Percutaneous mitral valvuloplasty (PMV) and mitral valve replacement (MVR) showed similar cardiovascular outcomes for severe mitral stenosis (MS). However, MVR was preferable for very severe MS due to fewer redo interventions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Valvular Heart Disease

Background:

  • Severe mitral stenosis (MS) diagnosis updated criteria: MVA ≤ 1.5 cm².
  • Rheumatic etiology is a common cause of MS.
  • Comparison of percutaneous mitral valvuloplasty (PMV) versus mitral valve replacement (MVR) is crucial for guiding treatment decisions.

Purpose of the Study:

  • To compare outcomes of PMV versus MVR in severe MS using updated criteria.
  • To evaluate the efficacy of PMV and MVR in different severity subgroups (moderately severe MS and very severe MS).
  • To determine the optimal intervention strategy based on patient characteristics and outcomes.

Main Methods:

  • Analysis of the Multicenter Mitral Stenosis With Rheumatic Etiology (MASTER) registry data.
  • Inclusion of 442 patients with severe MS undergoing PMV or MVR between 2000-2021.
  • Inverse probability-weighted matching for comparing primary (CV death, HF hospitalization) and secondary (primary outcomes + redo intervention) endpoints.

Main Results:

  • No significant difference in primary outcomes between PMV and MVR groups across all severe MS patients.
  • MVR group showed significantly fewer secondary outcomes (P=0.010) compared to PMV.
  • In very severe MS subgroup, MVR demonstrated better secondary outcomes (P=0.012) with fewer redo interventions.

Conclusions:

  • Neither PMV nor MVR significantly impacted cardiovascular mortality or heart failure hospitalizations in moderately severe MS or very severe MS.
  • Mitral valve replacement is recommended for very severe MS, especially when PMV morphology is not clearly suitable, due to a lower rate of early redo interventions.

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