Abstract 16110: Very Long-term (Up to 23 Years) Follow-up After Successful Mitral Balloon Valvuloplasty in a Large Series of Patients With Rheumatic Mitral Stenosis

• Published in: Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A16110
• Main Authors: Meneguz-Moreno, Rafael A, Costa, J Ribamar, Gomes, Nisia L, Ramos, Auristela I, Maldonado, Mercedes, Ferreira Neto, Alfredo N, Siqueira, Dimytri A, Esteves, Cesar A, Braga, Sérgio L, Abizaid, Alexandre
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 11.11.2016
• ISSN: 0009-7322; 1524-4539

IntroductionAlthough there has been a steady decline in the incidence of rheumatic heart disease, rheumatic mitral stenosis still causes significant morbi-mortality worldwide. Percutaneous mitral balloon valvuloplasty (PMBV) remains as the preferred treatment option for patients with suitable anatomy and severe symptomatic rheumatic mitral stenosis.HypothesisWe sought to assess the very long-term outcomes after successful PMBV.MethodsThis is a single center analysis of all consecutive patients who underwent successful PBMV (post-procedural valve area ≥ 1.5 cm and regurgitation moderate or less, without in-hospital major adverse cardiac and cerebrovascular events) between 1988 and 2011. The primary endpoint was to determine the incidence of major adverse cardiac events (MACE), including global death and need for mitral surgery or repeat PMBV up to 23 year after the procedure.ResultsAmong all 1577 patients, the success rate was achieved in 91.3% (1140 patients). The predictors of success were NYHA functional class III-IV (hazard ratio [HR]1.73, 95% CI1.15-2.60, p=0.008) and Wilkins-score < 8 (HR1.8, 95% CI1.24-2.63, p=0.002). Long-term follow-up (mean 15.6 ± 4.9 years; range 1 to 23) was obtained in 979 cases (68%). The incidence of the primary endpoint was 19.1% (95% CI17.0-21.1). The rate of global death, need for mitral surgery or repeat PMV was 0.6% (95% CI0.3-1.2), 8.3% (95% CI7.0-9.9), and 10.0% (95% CI8.5-11.7), respectively. Cumulative MACE-free survival at 23 years was 18.9 ± 0.2%. At multivariate analysis, NYHA functional class III-IV (p=0.008), worse leaflet mobility on Wilkins-score (p=0.001), age (p=0.007) and a trend towards male sex (p=0.06) were identified as independent predictors of the primary endpoint.ConclusionsUp to 23 years after successful PMBV, a sizeable proportion of patients still exhibit sustained results after PMBV.