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CLINICAL STUDIES

Is redo percutaneous mitral balloon valvuloplasty (PMV) indicated in patients with post-PMV mitral restenosis?

^a Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received July 25, 1997; revised manuscript received January 15, 1999, accepted March 26, 1999.

Reprint requests and correspondence: Dr. Igor F. Palacios, Director, Cardiac Catheterization Laboratory and Interventional Cardiology, Cardiac Unit, Bulfinch 105, Massachusetts General Hospital, 55 Fruit St., Boston, Massachusetts 02114
palacios.igor{at}mgh.harvard.edu

OBJECTIVES

The purpose of this study was to assess the immediate and long-term outcome of repeat percutaneous mitral balloon valvuloplasty (PMV) for post-PMV mitral restenosis.

BACKGROUND

Symptomatic mitral restenosis develop in 7% to 21% of patients after PMV. Currently, most of these patients are referred for mitral valve replacement. However, it is unknown if these patients may benefit from repeat PMV.

METHODS

We report the immediate outcome and long-term clinical follow-up results of 36 patients (mean age 58 ± 13 years, 75% women) with symptomatic mitral restenosis after prior PMV, who were treated with a repeat PMV at 34.6 ± 28 months after the initial PMV. The mean follow-up period was 30 ± 33 months with a maximal follow-up of 10 years.

RESULTS

An immediate procedural success was obtained in 75% patients. The overall survival rate was 74%, 72% and 71% at one, two, and three years respectively. The event-free survival rate was 61%, 54% and 47% at one, two, and three years respectively. In the presence of comorbid diseases (cardiac and noncardiac) the two-year event-free survival was reduced to 29% as compared with 86% in patients without comorbid diseases. Cox regression analysis identified the echocardiographic score (p = 0.03), post-PMV mitral valve area (p = 0.003), post-PMV mitral regurgitation grade (p = 0.02) and post-PMV pulmonary artery pressure (p = 0.0001) as independent predictors of event-free survival after repeat PMV.

CONCLUSIONS

Repeat PMV for post-PMV mitral restenosis results in good immediate and long-term outcome in patients with low echocardiographic scores and absence of comorbid diseases. Although the results are less favorable in patients with suboptimal characteristics, repeat PMV has a palliative role if the patients are not surgical candidates.

Abbreviations and Acronyms   MVR = mitral valve replacement   NYHA = New York Heart Association   PMV = percutaneous mitral balloon valvuloplasty

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