Predictors of Very Late Events after Percutaneous Mitral Valvuloplasty in Patients with Mitral Stenosis

• Published in: The American journal of cardiology 2016-06, Vol.117 (12), p.1978-1984
• Main Authors: Jorge, Elisabete, MD, Pan, Manuel, MD, PhD, Baptista, Rui, MD, Romero, Miguel, MD, PhD, Ojeda, Soledad, MD, PhD, de Lezo, Javier Suárez, MD, PhD, Faria, Henrique, MD, Calisto, João, MD, Monteiro, Pedro, MD, PhD, Pêgo, Mariano, MD, de Lezo, José Suárez, MD, PhD
• Format: Article
• Language: English
• Subjects: Age; Balloon Valvuloplasty - methods; Blood clots; Cardiac Catheterization - methods; Cardiovascular; Cause of Death - trends; Confidence intervals; Echocardiography; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - epidemiology; Incidence; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Stenosis - diagnosis; Mitral Valve Stenosis - physiopathology; Mitral Valve Stenosis - surgery; Morphology; Mortality; Patients; Portugal - epidemiology; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Prognosis; Prospective Studies; Pulmonary arteries; Retrospective Studies; Risk Factors; Spain - epidemiology; Surgery; Survival Rate - trends; Time Factors; Treatment Outcome; Ultrasonic imaging; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.03.051

Abstract Data on long-term outcomes of percutaneous mitral valvuloplasty (PMV) are still scarce. Also, the persistence of pulmonary hypertension (PH) after PMV is a complication which mechanisms and prognostic implications are unclear. Our aims were (i) to report the long-term outcomes of patients with rheumatic mitral stenosis (MS) treated with PMV; (ii) to determine the risk factors for long-term poor outcomes and (iii) to analyze the prevalence and predictors of persistent PH. We prospectively enrolled 532 patients who underwent PMV between 1987-2011 at 2 hospitals. The following endpoints were assessed post-PMV: all-cause mortality, mitral reintervention, a composite endpoint of all-cause mortality and mitral reintervention and PH persistence. Survival status was available for 97% patients; the median follow-up was 10 years (IQR 4-18 years). Procedural success was achieved in 85% patients. During the follow-up, 21% patients died and 27% required mitral reintervention. Before PMV, 74% patients had PH that persisted after PMV in 45% of patients ( P< 0.001). Unfavorable valve anatomy (Wilkins score>8) and post-PMV mean pulmonary arterial pressure (mPAP) were independent predictors of all-cause mortality, mitral reintervention and the composite endpoint. Post-PMV mPAP was significantly correlated with a mitral valve area (MVA)