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CLINICAL STUDIES

Retrograde nontransseptal balloon mitral valvuloplasty: immediate results and intermediate long-term outcome in 441 cases—a multicenter experience

Christodoulos I. Stefanadis, MD, FACC^*, Costas G. Stratos, MD^*, Spyros G. Lambrou, MD^*, Vinay Kumar Bahl, MD, Dennis V. Cokkinos, MD, FACC, Vassilios A. Voudris, MD, FACC, Stefanos G. Foussas, MD, FACC, Costas P. Tsioufis, MD^* and Pavlos K. Toutouzas, MD, FACC^*

^* Department of Cardiology of Athens University, Hippocration Hospital, Athens, Greece
All India Institute of Medical Sciences, New Delhi, India
Onassis Cardiac Surgery Center, Athens, Greece
Tzannio Hospital, Pireus, Greece

Manuscript received December 8, 1997; revised manuscript received April 13, 1998, accepted June 1, 1998.

Address for correspondence: Dr. Christodoulos Stefanadis, 9 Tepeleniou Street, Paleo Psychico 154 52, Athens, Greece

Objectives. Our aim was to present the immediate and intermediate long-term results of the application of retrograde nontransseptal balloon mitral valvuloplasty (RNBMV) in four cooperating centers from Greece and India.

Background. RNBMV is a purely transarterial method of balloon valvuloplasty, developed with the aim to avoid complications associated with transseptal catheterization. Only single-center experience with RNBMV has been previously reported.

Methods. The procedure was attempted in 441 patients with symptomatic mitral stenosis (320 women, 121 men, mean age [± SD] 44 ± 11 years, mean echocardiographic score [± SD] 7.7 ± 2.0) from 1988 to 1996. Three hundred eighty-five patients with successful immediate outcome were followed clinically for a mean [± SD] of 3.5 ± 1.9 (range, 0.5–9.1) years.

Results. A technically successful procedure was achieved in 388 (88%) cases. The echocardiographic score (p < 0.001), male gender (p = 0.005), preprocedural mitral regurgitation (p = 0.007) and previous surgical commissurotomy (p = 0.029) were unfavorable predictors of immediate outcome. Complications included death (0.2%), severe mitral regurgitation (3.4%) and injury of the femoral artery (1.1%). Event-free (freedom from cardiac death, mitral valve surgery, repeat valvuloplasty and NYHA class > II symptoms) survival rates (± SEM) were 100%, 96.9 ± 0.9%, 89.8 ± 1.9% and 75.5 ± 5.5% at 1, 2, 4 and 9 years, respectively. The echocardiographic score (p < 0.001), NYHA class (p = 0.008) and postprocedural mitral valve area (p = 0.009) were significant independent predictors of intermediate long-term outcome.

Conclusions. Multicenter experience indicates that RNBMV is a safe and effective technique for the treatment of symptomatic mitral stenosis. As with the transseptal approach, patients with favorable mitral valve anatomy derive the greatest immediate and intermediate long-term benefit from this procedure.

Abbreviations and Acronyms   FA = femoral artery   FU = follow-up   LA = left atrial, left atrium   LV = left ventricle, left ventricular   MR = mitral regurgitation   MVA = mitral valve area   MVR = mitral valve replacement   NYHA = New York Heart Association   RNBMV = retrograde nontransseptal balloon mitral valvuloplasty

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