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Long-term follow-up of percutaneous balloon mitral valvuloplasty for rheumatic mitral stenosis
Session:
Comunicações Orais - Sessão 02 - Intervenção não coronária
Speaker:
Sofia Jacinto
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:
Sofia Jacinto; André Paulo Ferreira; Luís Almeida Morais; Luís Bernardes; Duarte Cacela; Inês Rodrigues; Ana Galrinho; Luísa Moura Branco; Ana Teresa Timóteo; Pedro Rio; Cristina Soares; Cristina Fondinho; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background: </strong>Percutaneous balloon mitral valvuloplasty (PBMV) remains the mainstay of treatment for patients with severe rheumatic mitral stenosis (MS) and a favorable anatomy.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Aim:</span></strong><span style="color:black"> The present study aimed to assess very long-term outcomes after PBMV.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> <span style="color:black">A retrospective analysis of PBMV performed at a single tertiary center between August 1991 and September 2022 was conducted. Successful PBMV was defined as a post-procedural functional mitral valve area (MVA) ≥1.5 cm2, mitral regurgitation less than moderate, and absence of in-hospital major cardiac or cerebrovascular events. The primary endpoint was composed of overall mortality and need for mitral reintervention (percutaneous and/or surgical). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong><span style="color:black">: A total of 238 PBMV for severe rheumatic MS were conducted in our center during the specified timeframe (88.7% [n=211] female gender; mean age 48 ± 16 years; 48.6% [n=108] had atrial fibrillation [AFib]; 78.8% [n=149] had a Wilkins score ≤8). Acute success was achieved in 88% (n=198) procedures. Acute complications were present in 10.2% (n=23), mainly severe mitral regurgitation (n=10) and acute cerebrovascular events (n=5). During a mean follow-up of 15.3 ± 9.4 years, the incidence of the primary endpoint was 55% (n=131) (overall mortality 32.9% [n=77] and mitral valve reintervention 22.1% [n=54]). </span>On bivariate analysis, higher age (p=0.042), presence of AFib (p=0.002), <span style="color:black">unsuccess of the procedure (p<0.001), acute </span>complications (p=0.001) and larger left atrial (LA) diameter (p=0.05) were statistically significant for the occurrence of the primary endpoint. On multivariate analysis, larger LA diameter (hazard ratio [HR]: 1.03; 95% <span style="color:black">CI: 1.00-1.06; p=0.022), unsuccessful procedure (HR: 3.30; 95% CI: 1.56-7.01; p=0.002) and presence of complications </span>(HR: 0.37; 95% CI: 0.17-0.84; p=0.017) were the only independent predictors of the primary endpoint.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong>: In one of the largest national registries of patients submitted to PBMV for <span style="color:black">severe rheumatic MS, more than half met the primary endpoint for overall mortality or need for reintervention, up to 30 years after the procedure. This supports the dismal prognosis of this pathology. Prediction of late favorable results is multifactorial and appears to be determined by smaller LA diameter, absence of complications and acute success of the procedure.</span></span></span></span></p>
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