Comparative results of percutaneous balloon mitral valvuloplasty using the Trefoil/Bifoil and Inoue balloon techniques
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1Department of Cardiology, Johannesburg Hospital, South Africa.
Insights
Percutaneous balloon mitral valvuloplasty effectively treats mitral stenosis. The Inoue balloon catheter offers similar outcomes to the Trefoil/Bifoil catheter but with a simpler technique and lower cost, making it suitable for resource-limited settings.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Rheumatic mitral stenosis remains a significant global health concern, particularly in developing nations.
- Percutaneous balloon mitral valvuloplasty (PBMV) is a key therapeutic option for managing mitral stenosis.
Purpose of the Study:
- To compare the efficacy and safety of the Trefoil/Bifoil balloon catheter versus the Inoue balloon catheter for PBMV in patients with rheumatic mitral stenosis.
- To evaluate procedural outcomes, including mitral valve area, hemodynamic parameters, and complication rates.
Main Methods:
- A comparative study involving 150 patients with rheumatic mitral stenosis undergoing PBMV.
- Patients were divided into two groups: Group 1 (n=100) using the Trefoil/Bifoil catheter and Group 2 (n=50) using the Inoue catheter.
- Echocardiographic and hemodynamic parameters were assessed pre- and post-procedure.
Main Results:
- Both techniques significantly improved mitral valve area (P < 0.001) with no significant difference between groups post-procedure.
- The Trefoil/Bifoil technique required longer screening times (39 ± 15 min vs. 22 ± 10 min; P < 0.001).
- A higher complication rate was observed in the Trefoil/Bifoil group, attributed to the learning curve.
Conclusions:
- Both Trefoil/Bifoil and Inoue balloon catheters are effective for PBMV in mitral stenosis.
- The Inoue balloon catheter offers a simpler, faster procedure with comparable results, and its lower cost is advantageous for healthcare systems with limited resources.
- The findings highlight the importance of catheter choice in resource-constrained environments for managing rheumatic heart disease.
Abstract:
This study compared the results in 150 consecutive patients with rheumatic mitral stenosis who underwent percutaneous balloon mitral valvuloplasty by means of a Trefoil/Bifoil balloon catheter (n = 100, Group 1) or the Inoue balloon catheter (n = 50, Group 2). There was significant improvement in mitral valve area after valvuloplasty in both groups: in Group 1 mitral valve area improved from 0.92 +/- 0.22 to 2.14 +/- 0.64 cm2 (P < 0.001) and in Group 2 from 1.0 +/- 0.26 to 2.06 +/- 0.59 cm2 (P < 0.001). There was no significant difference in the mitral valve area, mean diastolic gradient or mean left atrial pressure between Group 1 and Group 2 patients after valvuloplasty. There was a higher complication rate in Group 1 patients but this was largely related to our early learning experience with the procedure. The Trefoil/Bifoil catheter technique is more complex and involved a longer screening time: Group 1 (39 +/- 15 min) vs. Group 2 (22 +/- 10 min); P < 0.001. The cost of the Inoue balloon technique, however, was almost twice that of the Trefoil/Bifoil technique. This may have important implications for developing countries with limited health care budgets and a high prevalence of rheumatic heart disease.