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Percutaneous mitral balloon valvotomy in patients with calcific mitral stenosis: immediate and long-term outcome
E M Tuzcu1, P C Block, B Griffin
1Department of Medicine, Massachusetts General Hospital, Boston 02114.
Insights
Percutaneous balloon mitral valvotomy outcomes are less successful in patients with mitral valve calcification. Fluoroscopically visible calcification negatively impacts immediate and long-term results, including survival rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Mitral valve calcification is a known factor influencing outcomes in surgical mitral commissurotomy.
- Patient selection is critical for successful percutaneous balloon mitral valvotomy (PBMV).
Purpose of the Study:
- To analyze the immediate and long-term outcomes of PBMV in patients with and without fluoroscopically visible mitral valve calcification.
- To compare PBMV results based on the severity of mitral valve calcification.
Main Methods:
- A comparative study of 155 patients with calcified mitral valves and 173 patients without.
- Patients with calcified valves were stratified into four groups based on calcification severity.
- Immediate and long-term results, including mitral valve area, success rates, and survival, were assessed.
Main Results:
- Patients with calcified valves had poorer baseline characteristics and smaller mitral valve areas post-PBMV.
- Successful PBMV (mitral valve area > 1.5 cm²) was achieved in 52% of calcified cases versus 69% of non-calcified cases (p=0.001).
- Two-year survival (80% vs. 99%), event-free survival (63% vs. 88%), and survival without valve replacement (67% vs. 93%) were significantly worse in patients with calcified valves.
Conclusions:
- Fluoroscopically visible mitral valve calcification is associated with less successful immediate and long-term outcomes following PBMV.
- The severity of mitral valve calcification directly correlates with progressively worse survival and event-free survival rates.
Objectives:
This study analyzed the immediate and long-term outcome of percutaneous balloon mitral valvotomy in patients with and without fluoroscopically visible mitral valve calcification.
Background:
Mitral valve calcification has been shown to be an important factor in determining immediate and long-term outcome of patients undergoing surgical mitral commissurotomy. Patient selection has an important impact on the outcome of percutaneous balloon mitral valvotomy.
Methods:
The immediate and long-term results of percutaneous balloon mitral valvotomy were compared in 155 patients with and 173 patients without mitral valve calcification. The patients with calcified valves were assigned to four groups according to severity of calcification.
Results:
Patients with calcified mitral stenosis more frequently were in New York Heart Association functional class III or IV and more frequently had atrial fibrillation, previous surgical commissurotomy, echocardiographic score > 8, higher pulmonary artery and left atrial pressures, higher pulmonary vascular resistance and mean mitral valve gradient and lower cardiac output and smaller mitral valve area. Mitral valve area after valvotomy was significantly smaller in patients with calcified valves (1.8 +/- 0.06 vs. 2.1 +/- 0.06 cm2) and was > or = 1.5 cm2 in 65% of patients with and 83% of patients without calcified valves (p = 0.004). A successful outcome, defined as mitral valve area > 1.5 cm2 without significant mitral regurgitation and left to right shunting, was achieved in 52% of patients with and 69% of patients without uncalcified valves (p = 0.001). The success rate was 59%, 48%, 35% and 33% in subgroups with 1+, 2+, 3+ and 4+ calcification, respectively. The rates of significant left to right shunting and mitral regurgitation after valvuloplasty were similar in the two groups. Estimated survival rate (80% vs. 99%, respectively, p = 0.0001), survival rate without mitral valve replacement (67% vs. 93%, respectively, p < 0.00005) and event-free survival rate (63% vs. 88%, respectively, p < 0.00005) at 2 years were significantly better in the patients with uncalcified valves. Survival rate curves became progressively worse as the severity of calcification increased.
Conclusions:
These findings indicate that immediate and long-term results of mitral valvuloplasty are not as successful in patients with fluoroscopically visible mitral valve calcification as in those without calcification.