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Impact of Procedural Success Definitions on Long-Term Outcomes in Patients With Rheumatic Mitral Stenosis Treated

Premanan Manoret1, Tasalak Thonghong2, Krissada Meemook3

  • 1Cardiology Unit, Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Songkhla Thailand.

Journal of the American Heart Association
|August 9, 2024
PubMed

Insights

Choosing the right success definition for percutaneous balloon mitral valvuloplasty (PBMV) impacts patient outcomes. A specific definition combining mitral valve area and mitral regurgitation grades offers the most favorable long-term results.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Valvular Heart Disease

Background:

  • Uncertainty exists regarding optimal success definitions for percutaneous balloon mitral valvuloplasty (PBMV).
  • Lack of comparative studies hinders the selection of appropriate PBMV success criteria.
  • This study investigates the prognostic impact of different PBMV success definitions on long-term outcomes.

Purpose of the Study:

  • To evaluate the association between three distinct PBMV success definitions and long-term clinical outcomes.
  • To identify the most prognostically significant success criteria for PBMV in rheumatic mitral stenosis.
  • To guide the selection of standardized PBMV success metrics.

Main Methods:

  • Multicenter retrospective study of severe rheumatic mitral stenosis patients undergoing PBMV.
  • Evaluation of three success definitions based on post-PBMV mitral valve area (MVA) and mitral regurgitation (MR) severity.
  • Multivariable Cox regression analysis to assess the composite outcome of mortality, mitral surgery, and repeat PBMV.

Main Results:

  • All three evaluated PBMV success definitions were associated with a reduced risk of adverse composite outcomes.
  • Hazard ratios for the composite outcome were consistent across definitions A, B, and C (HR 0.55).
  • Patients meeting all three success criteria demonstrated the lowest risk of adverse outcomes compared to those meeting fewer criteria.

Conclusions:

  • All three PBMV success definitions demonstrate prognostic value.
  • A definition incorporating post-PBMV MVA ≥1.5 cm², regardless of percentage increase, and MR ≤ grade 2 with no more than a 1-grade increment is associated with the most favorable outcomes.
  • Standardizing PBMV success definitions is crucial for consistent patient management and outcome prediction.
Abstract

Keywords:
PBMVcomplicationslong‐term outcomepercutaneous balloon mitral valvuloplastyrheumatic mitral stenosissuccess definitions

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