Balloon mitral valvotomy: comparison between antegrade Inoue and retrograde non-transseptal techniques

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Mitral stenosis management often involves percutaneous mitral valvotomy (PMV).
• Two primary PMV techniques exist: antegrade transseptal using the Inoue balloon and retrograde non-transseptal using a polyethylene balloon.

Purpose of the Study:

• To compare the efficacy and safety of Inoue balloon PMV versus retrograde non-transseptal PMV.
• To evaluate immediate and 1-year outcomes, including mitral valve area, procedural success, and complications.

Main Methods:

• Retrospective, non-randomized comparison of 1000 patients (Inoue balloon, Group 1) and 100 patients (retrograde, Group 2).
• Assessment of mitral valve area by Gorlin's equation and Doppler echocardiography (pressure half-time method).
• Evaluation of procedural success, optimal results, mitral regurgitation, shunts, tamponade, conduction disturbances, and procedure time.

Main Results:

• Both techniques significantly increased mitral valve area (P < 0.001).
• Inoue technique yielded a larger immediate mitral valve area (P < 0.02), with similar optimal results (95% vs 94%) and significant mitral regurgitation (4% vs 5%).
• Retrograde technique showed higher local complications (3% vs 0.5%, P < 0.01) and longer procedure time (22 vs 15 min). Inoue technique had exclusive atrial shunts (2.5%) and tamponade (2%).

Conclusions:

• Both Inoue balloon and retrograde PMV provide significant hemodynamic and symptomatic improvement.
• The Inoue technique achieves a larger immediate mitral valve area, but this difference is not sustained at 1-year follow-up.
• Local complications are more frequent with the retrograde technique, while the Inoue technique carries risks of shunts and tamponade; both techniques can be complementary.