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Percutaneous balloon mitral valvuloplasty for mitral stenosis patients: an old but reliable weapon
Session:
Comunicações Orais (Sessão 21) - Intervenção Cardíaca Coronária e Estrutural 3 - Vários Tópicos
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2022
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:
Vera Ferreira; Inês Rodrigues; Luís Almeida-Morais; Luís Bernardes; Duarte Cacela; Lino Patrício; Alexandra Castelo; Pedro Garcia Brás; André Grazina; Luísa Moura Branco; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background: In the era of transcatheter intervention, percutaneous balloon mitral valvuloplasty (PBMV) remains the primary treatment option in anatomic suitable patients.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Purpose: This study aimed to evaluate longterm follow-up (FU) of PBMV and to determine predictors of MACE. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Between 1991 and June 2021, 202 consecutive patients underwent PBMV in a single tertiary center. <span style="background-color:white"><span style="color:black">Clinical data, echocardiographic parameters, and MACE (cardiovascular mortality, </span></span>need for percutaneous or surgical mitral reintervention and hospitalization for heart failure)<span style="background-color:white"><span style="color:black"> were analysed. </span></span>Predictors of MACE were determined by Cox regression analysis. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean age was 47.3±13.6 years, 89.6% female, 47.3% patients presenting atrial fibrillation. Mean Wilkins score was 7.6±1.4, 51.5% had mild or moderate mitral regurgitation and mean pulmonary artery systolic pressure (PASP) of 46.7±17.1 mmHg. Mean pre MVA and mean mitral valve (MV) gradient were 1.1±0.2 cm2 and 10.8±5.6 mmHg, respectively. Successful PMBV was achieved in <span style="color:black">89.1% and 3.0% suffered procedural complications, including one cardiogenic shock, 3 urgent cardiac surgeries and 2 deaths (stroke and cardiac tamponade).</span></span></span> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a mean FU of 12.0±8.8 years, there were 25 deaths (12.4%) and 33.3% needed MV reintervention (6.5% underwent PBMV and 29.7% needed MV surgery). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At univariate analysis, previous MV intervention [HR=1.95 (1.02–3.72), p<0.05], Wilkins score [HR=1.22 (1.01–1.47), p<0.05], pre mean MV gradient≥8 [HR=0.62 (0.38–1.00), p<0.05], mean MV gradient after procedure [HR=1.37 (1.19–1.58), p<0.05] and PASP >45 mmHg [HR=3.29 (1.13–9.55), p<0.05] were predictors of MV reintervention. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At multivariate analysis, pre mean MV gradient≥8 [HR=0.17 (0.037–0.81), p<0.05] and mean MV gradient after procedure were independent predictors of MV reintervention [HR=1.74 (1.21–2.49), p<0.05]. Wilkins score [HR=1.29 (1.06–1.57), p<0.05] and mean MV gradient after procedure [HR=1.41 (1-21–1.63), p<0.05] were independent predictors of MACE. Cumulative event-free survival at 10 and 20 years were 72.0 and 46.0%, respectively.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions: PBMV remains a reliable and efficient therapeutic option of mitral stenosis, warranting event-free survival at 10 years in most patients selected for the procedure. Mean MV gradient after procedure was independent predictors of MV reintervention and MACE during follow-up.</span></span></p>
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