SPC365

20 year-follow up of mitral stenosis patients after percutaneous valve commissurotomy: invasive transmitral pressure gradient diferential as a predictor of events

Session: Comunicações Orais - Sessão 02 - Intervenção não coronária
Speaker: Ana Amador

Congress: CPC 2023
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Amador; Catarina Costa; João Calvão; André Cabrita; Catarina Marques; Ana Pinho; Cátia Oliveira; Luís Santos; Helena Moreira; Miguel Rocha; Pedro Palma; Mariana Paiva; João Carlos Silva; Filipe Macedo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Background:&nbsp; </span></span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Percutaneous valve commissurotomy (PMC) is a viable alternative to mitral valve (MV) surgery in the treatment of patients (pts) with clinically significant mitral stenosis (MS). About 40% of pts treated with PMC will require at least one reintervention (either PMC or MV surgery) along time. The aim of our study was to evalute the long-term results of PMC in pts with&nbsp;rheumatic MS and to seek for an immediate intra operative predictor of events.</span></span></span></span></p>

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

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results: </span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">A total of 124 pts were enrolled: 108 (87%) female, mean age at the time of PMC of 46 &plusmn; 11 years.&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">At baseline, 34% pts were in NYHA class &ge;III and 81% had a Wilkins score &le; 8; all patients had preserved biventricular systolic function and 83% presented pulmonary hypertension. In 20 cases, there was concomitant moderate disease of other valve (3/4 tricuspid regurgitation).</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">Most of the procedures were successful (91%) and without complications (94%), with a median reduction in pulmonary artery systolic pressure PASP of 8 mmHg (IQR 10) and a mean reduction in mitral valve gradient of 8&plusmn;7 mmHg. </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 the mean follow-up of 20 &plusmn; 6 years, 51 (42%) of patients had MV re-intervention (86% surgery and 14% re-PMC), 37 (30%) were hospitalized and 30 (24%) died. Concerning time-to-event analysis, approximately 80% of patients kept MACE-free after 10 years; after 30 years, more than 20% continued MACE-uneventful, approximately 50% were alive and about 45% were free from re-intervention.</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">Using Cox regression, we found that a reduction &lt;5 mmHg in transmitral pressure gradient at PMC time (before and immediately after PMC) was associated with a 2,1-fold greater rate of MACE compared to pts with a reduction &ge; 5 mmHg (HR<sub>crude</sub>=2,2; 95%CI 1,319-3,813 p=0,003). After adjusting for the presence of mitral regurgitation after PMC (HR<sub>crude</sub>=1,7; 95%CI 1,020-2,950, p=0,042) and for moderate disease of other valves (HR<sub>crude</sub> 1,9; 95%CI 1,070-3,267, p=0,028) the observed effect remained significant and was even greater (HR<sub>adjusted</sub> = 2,7; 95% CI 1,395-5,298, p=0,003). </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">Of note, diferential in PSAP or in left atrium pressure intra-operatorive did not show an association with occurrence of events (p=0,285 and p=0,769).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusion:</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">&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</span></span>. Most of the patients were free from adverse events after 10 years and half were alive after 30 years; still, about 40% required re-intervention. A reduction &lt;5 mmHg in transmitral&nbsp;gradient at PMC time was associated with events during follow up; more studies are needed to validate this pratical independent predictor.</span></span></span></p>