SPC365

Is Wilkins score over 9 a definitive limit to favorable long-term success in percutaneous valve commissurotomy?

Session: Posters (Sessão 1 - Écran 8) - Doença Valvular 1 - Vários
Speaker: Miguel Martins de Carvalho

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: Pósters Electrónicos
FP Number: ---
Authors: Miguel Martins de Carvalho; Ricardo Alves Pinto; Tânia Proença; João Calvão; Catarina Costa; Ana Filipa Amador; Catarina Marques; André Cabrita; Luís Santos; Cátia Priscila; Ana Pinho; Mariana Paiva; João Carlos Silva; Filipe Macedo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Background:&nbsp;Percutaneous valve commissurotomy (PMC) is an established treatment in patients with significative mitral stenosis (MS). Although rheumatic MS incidence has decreased in the last century, it remains a prevalent pathology worldwide. The Wilkins score (WS) is a reference in echocardiographic assessment of MS; a score &le;8 is considered a predictor of treatment success and score between 9 and 11 is a &ldquo;gray zone&rdquo; (WGZ) in which doubts persists regarding PMC success.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Purpose:</span> &nbsp;To evaluate the early and long-term results of PMC in patients with rheumatic MS and to compare long-term events between patients with WS <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">&le; 8 </span></span>and patients in WGZ.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods:&nbsp;We retrospectively analysed all patients between 1991 and 2008 with <span style="color:#333333">significative rheumatic MS undergoing PMC. Data were collected at baseline and during long-term follow-up. MACE was defined as</span></span> <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">a composite of all-cause mortality, mitral valve re-intervention or cardiovascular hospitalization.</span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results: In our cohort, 124 patients were included. Most were female (87%), mean age at the time of repair was 46 &plusmn; 11 year-old and mean follow-up was 20 &plusmn; 6 years. Before the procedure, 81% had WS <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">&le; 8 and 19% were in WGZ. Both groups had similar baseline characteristics, namely age at first intervention, NYHA class and follow-up time. &nbsp;A</span></span>ll patients had preserved biventricular systolic function, 83% presented PH, mean transvalvular gradient (TVG) and mitral valve area (MVA) were 12.8 mmHg and 1.0 cm<sup>2</sup>, respectively. Most of the procedures were successful (91%) and without complications (94%). Mean MVA improvement was similar in both groups [0.9 cm<sup>2</sup> in WS <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">&le; 8 and </span></span>0.8 cm<sup>2</sup> in WGZ, t(102)=0.173, p=0.863]; there was also no significative difference&nbsp; in TVG and PASP reduction after PMC. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">During long-term follow-up, re-intervention and mortality occurred in 40% and 23% in WS <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">&le; 8 and in 50% and 29% in </span></span>WGZ, respectively, and none of these differences was statically significant (p=0.389 and p=0.544, respectively). Concerning time-to-event analysis, approximately 80% of patients kept uneventful and &gt;90% alive after 10 years</span><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> in both groups and no significant difference in MACE events and all-cause mortality between </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">WS <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">&le; 8 and </span></span>WGZ was observed </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">(Log Rank, p=0,419 and p=0.950, respectively).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusion:&nbsp;PMC was safe and effective in <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">clinically significant rheumatic MS in both </span></span>WS <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">&le; 8 and </span></span>WS 9-11, with similar MVA improvement. After 10 years,</span> <span style="font-family:&quot;Calibri Light&quot;,sans-serif">approximately 80% of patients maintained MACE-free and &gt;90% alive </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">in both groups. T</span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">here was no difference in all-cause mortality and in a composite of <span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">all-cause death, mitral valve re-intervention or cardiovascular hospitalization concerning WS groups.</span></span></span></span></span></p>