Inoue balloon mitral valvotomy in patients with severe valvular and subvalvular deformity

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe mitral valve and subvalvular deformity poses significant therapeutic challenges.
• Percutaneous mitral valvotomy is an alternative to surgical intervention.

Purpose of the Study:

• To evaluate the immediate and long-term outcomes of percutaneous Inoue balloon mitral valvotomy.
• To identify predictors of success and adverse events in patients with severe mitral valve deformity.

Main Methods:

• Retrospective review of 72 patients from the North American multicenter Inoue registry with severe mitral deformity (MGH score >= 10).
• Echocardiograms were rescored to assess valvular and subvalvular morphology.
• Clinical follow-up assessed events including mitral valve replacement, repeat valvotomy, or death.

Main Results:

• Technical success was achieved in 96% of patients, with a significant increase in mitral valve area.
• An immediate optimal result was obtained in 64% of patients.
• At mean follow-up of 22.9 months, 31% required reintervention, and 13% died; 45% were in NYHA class I or II.
• Sinus rhythm predicted an immediate optimal result; lower mitral regurgitation grade predicted event-free survival.

Conclusions:

• Inoue mitral valvotomy offers high technical success and immediate hemodynamic improvement for severe mitral deformity.
• However, a significant rate of cardiovascular events necessitates consideration of mitral valve replacement for surgical candidates.
• Balloon valvotomy remains a palliative option for high-risk patients.