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Predictors of long-term event-free survival after percutaneous balloon mitral valvuloplasty
G S Pavlides1, G T Nahhas, J London
1Onassis Cardiac Surgery Center, Kalithea, Greece.
Insights
Long-term survival after percutaneous balloon mitral valvuloplasty (PBMV) depends on baseline characteristics. Mitral valve morphology (echo score) and mitral valve area (pre- and post-procedure) are the strongest predictors of event-free survival following PBMV.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous balloon mitral valvuloplasty (PBMV) is a treatment for mitral stenosis.
- Predicting long-term event-free survival after PBMV is crucial for patient management.
- Previous studies identified some predictive variables, but a comprehensive analysis was lacking.
Purpose of the Study:
- To accurately define the baseline and procedural variables that predict long-term event-free survival after PBMV.
- To identify independent predictors of event-free survival using multivariate analysis.
Main Methods:
- Analysis of 40 baseline demographic, clinical, echocardiographic, and hemodynamic variables in 128 mitral stenosis patients undergoing PBMV.
- Univariate and multivariate Cox proportional hazard analyses were performed.
- Event-free survival was defined as freedom from death, mitral valve replacement, or repeat PBMV.
Main Results:
- Univariate analysis identified age, prior interventions, calcium grade, echo score, preprocedure cardiac output, preprocedure valve area, postprocedure mean left atrial pressure, postprocedure valve area, postprocedure valve gradient, and postprocedural mitral regurgitation as significant predictors.
- Procedural changes in left atrial pressure, valve area, and valve gradient also predicted survival.
- Multivariate analysis revealed echo score and preprocedure valve area as independent predictors when only baseline variables were considered.
- Echo score and postprocedure valve area were independent predictors when both pre- and postprocedure variables were included.
Conclusions:
- Mitral valve morphology, assessed by echo score, is a key predictor of outcomes after PBMV.
- Baseline and postprocedure mitral valve area are the strongest independent predictors of long-term event-free survival following PBMV.
- These findings can aid in patient selection and risk stratification for PBMV procedures.
Abstract:
Previous studies have shown that long-term event-free survival after percutaneous balloon mitral valvuloplasty (PBMV) could be predicted by several baseline characteristics. However, the extent of the predictive variables has not been defined accurately yet. In this study, 40 baseline demographic, clinical, echocardiographic, and hemodynamic variables of 128 consecutive patients with mitral stenosis who underwent PBMV in a single institution, were analyzed in order to predict long-term event-free survival, defined as absence of death, mitral valve replacement, or repeat PBMV. Univariate survival analysis showed that age (p = 0.03), history of commissurotomy or mitral valvuloplasty (p = 0.05), calcium grade (p = 0.008), echo score (p = 0.0001), preprocedure cardiac output (p = 0.03), preprocedure valve area (p = 0.0007), postprocedure mean left atrial pressure (p = 0.0001), postprocedure valve area (p = 0.0001), postprocedure valve gradient (p = 0.013), and postprocedural mitral regurgitation (p = 0.01) were statistically significant predictors of event-free survival. Additionally, the absolute and/or relative procedural change of the following variables were found to be statistically significant predictors of event-free survival: left atrial pressure (p = 0.01), valve area (p = 0.0001), and valve gradient (p = 0.02). Multivariate Cox proportional hazard analysis indicated that when only variables available before the procedure were considered, echo score (p = 0.002) and preprocedure valve area (p = 0.0002) were found to be independent predictors of event-free survival. When both pre- and postprocedure variables were considered, echo score (p = 0.002) and postprocedure valve area (p = 0.0001) were found to be independent predictors of event-free survival. In conclusion, mitral valve morphology reflected by echo score, and baseline and postprocedure mitral valve area were found to be the strongest independent predictors of event-free survival after PBMV.