SPC365

Clinical and echocardiographic very long-term outcomes after percutaneous mitral balloon valvuloplasty in severe rheumatic mitral stenosis

Session: Comunicações Orais (Sessão 3) - Doença valvular
Speaker: João Presume

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: João Presume; Mariana Paiva; Daniel Gomes; Francisco Albuquerque; Joana Ferreira; Sara Guerreiro; Liliana Marta; Pedro Freitas; Marisa Trabulo; João Abecasis; Maria João Andrade; Pedro Araújo Gonçalves; Manuel Almeida; Miguel Mendes; Regina Ribeiras

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Introduction</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">Mitral balloon valvuloplasty (MBV) is the guideline recommended treatment for symptomatic severe mitral stenosis (MS) with suitable anatomy, but is often deemed transitory. However, data on very-long term echocardiographic follow-up is scarce. The aim of our study was to describe clinical and echocardiographic outcomes in patients previously submitted to MBV for rheumatic MS. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Methods</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">We conducted a single-centre retrospective study enrolling patients previously submitted to MBV for rheumatic MS from 1990 until 2021. Follow-up was registered until the last echocardiographic re-evaluation available. Patients without electronic health records available were excluded. The primary endpoint was a composite of all-cause death or need of surgery.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Results</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">A total of 193 patients were included (15.5% male, with a mean age of 52&plusmn;15 years at the time of MBV, 60.6% with permanent atrial fibrillation). During a mean follow-up of 11&plusmn;8 years, 87 (45.1%) patients implanted a mitral valve prosthesis, 4 (2.1%) were submitted to surgical mitral valvuloplasty and 30 (15.5%) died without being reinterventioned. Moreover, a total of 23 (11.9%) embolic events were registered - 21 strokes, 1 pulmonary embolism and 1 acute lower limb embolism.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">Overall, 133 patients (68.9%) survived more than 5 years, 95 (49.2%) more than 10 years and 56 (26.9%) more than 15 years since MBV without meeting the primary endpoint. The maximum follow-up without intervention was 32 years. Concerning patients submitted to surgery, the mean time from MBV until operation was 9.4&plusmn;7.3 years (minimum 8 days; maximum 29.3 years). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">In regard to echocardiographic long-term outcomes on alive non-operated patients (mean follow-up of 12&plusmn;9 years), 52.8% remain with mild MS, 91.6% with mild or no mitral regurgitation and 77.6% with mild or no tricuspid regurgitation. Furthermore, only 20.4% have right ventricle dysfunction (defined as a TAPSE &lt;17mm), 18.3% have pulmonary hypertension (pulmonary artery systolic pressure &gt;45mmHg), and 6.8% have residual interatrial communication. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Conclusion</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">MBV is a minimally invasive procedure that has an important benefit in a very significant proportion of patients with rheumatic mitral stenosis, with potential benefit that may last more than three decades without need for another invasive intervention.</span></span></span></p>