Three-quarters of patients have sustained results at very long-term follow-up after percutaneous balloon mitral valve valvuloplasty

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Rafael A Meneguz-Moreno (Department of Interventional Cardiology, Instituto Dante Pazzanese De Cardiologia, Sao Paulo, Brazil) and others report on JACC: Cardiovascular Interventions that after very long-term follow-up, 75% (i.e three quarters) of patients exhibit sustain results after undergoing percutaneous balloon mitral valve valvuloplasty. They add that the predictors of such results include age, previous symptoms, and post-procedural mitral valve area.

The authors report that although percutaneous balloon mitral valve valvuloplasty is seen as the gold-standard approach for managing severe symptomatic rheumatic mitral valve stenosis (in patients with suitable anatomy), there is a paucity of very long-term outcome data for patients undergoing the procedure. “In the present study, we report immediate and very long-term clinical and echocardiographic follow-up results of a large series of consecutive patients who underwent percutaneous balloon mitral valve valvuloplasty,” they write.

Reviewing registry data from their centre, Meneguz-Moreno et al identified 1,582 consecutive patients who underwent percutaneous balloon mitral valve valvuloplasty between August 1987 and July 2011. They found that at the very long-term follow-up point (23 years), the incidence of the primary endpoint—the composite of all-cause mortality, need for mitral surgery, and need for repeat percutaneous balloon mitral valve valvuloplasty—was 19.1%.

The majority (93.1%) of patients, of those who had a successful procedure, had improvements in New York Heart Association (NYHA) function class within the first year. The authors note: “Of those, only 13% developed NYHA functional class III or IV symptoms throughout the follow-up period.” They add in a multivariate analysis, the only predictors of the primary endpoint were NYHA functional class III or IV at baseline, age, and mitral valve area immediately after the procedure.

Concluding, the Meneguz-Moreno et al comment: “After more than 30 years since its introduction, stpercutaneous balloon mitral valve valvuloplay represents a reasonable therapeutic option for the treatment of the most patients with rheumatic mitral valve stenosis.” They add their study shows that “two decades” after a successful procedure, “more than 75% of followed patients still exhibited sustained results.”

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