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Percutaneous mitral commissurotomy in the elderly
European Heart Journal
|August 1, 1995
Summary
Percutaneous mitral commissurotomy (PMC) offers moderate valve function improvement in elderly patients with acceptable risk. However, functional decline is common, making PMC a useful palliative treatment for severe mitral stenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Severe mitral stenosis poses significant risks in elderly patients.
- Percutaneous mitral commissurotomy (PMC) is an alternative to surgical intervention.
- Outcomes of PMC in patients aged 70 years and older require thorough evaluation.
Purpose of the Study:
- To assess the immediate and mid-term outcomes of PMC in elderly patients (>= 70 years).
- To identify predictors of initial success and long-term functional results after PMC.
- To evaluate the safety and efficacy of PMC in a geriatric population.
Main Methods:
- Seventy-five patients aged >= 70 years with severe mitral stenosis underwent PMC.
- Procedural success was defined by achieving a valve area >= 1.5 cm2 and mitral regurgitation <= 214.
- Follow-up included assessment of survival, need for surgery, and functional status (NYHA class).
Main Results:
- Good initial results were achieved in 66% of patients, with a significant increase in valve area.
- Procedural mortality was 4%.
- Four-year actuarial outcomes showed 59% survival, 59% freedom from operation, and 34% persistent good functional results.
Conclusions:
- PMC provides moderate, significant valve function improvement in elderly patients at acceptable risk.
- Valve calcification and prior commissurotomy predict poorer initial results.
- While PMC is a useful palliative option, subsequent functional deterioration is frequent, highlighting the need for careful patient selection and management.